MedicaidPrior AuthMedium impact
MAB2025111403
Pennsylvania Medicaid (DHS)·PA · Rheumatology, Nephrology, Transplant Surgery +1 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for oral immunosuppressive medications, clarifying that non-preferred drugs will be evaluated against therapeutically equivalent brands and generics. No other changes to medical necessity guidelines were made.
Action Required
By January 5, 2026: Pharmacy and prescribing teams must update prior authorization workflows for oral immunosuppressives to ensure documentation shows consideration of therapeutically equivalent alternatives when requesting non-preferred drugs. Review current Lupkynis (voclosporin) authorization requirements and verify specialist involvement and combination therapy restrictions are documented. Claims may be denied without proper prior authorization.