MedicaidPrior AuthMedium impact
MAB2025110701
Pennsylvania Medicaid (DHS)·PA · Cardiology, Family Medicine, Internal Medicine +2 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing revised prior authorization requirements for calcium channel blocker medications, with new guidelines for combination products containing multiple active ingredients. The changes affect both fee-for-service and managed care Medicaid delivery systems.
Action Required
Before January 5, 2026: Billing and clinical teams must review updated prior authorization requirements for calcium channel blockers under Pennsylvania Medicaid. For non-preferred combination products (e.g., amlodipine-atorvastatin), ensure prescribers document clinical reasons why individual active ingredients cannot be used concurrently. Update prior authorization request procedures to include new medical necessity criteria for combination calcium channel blocker products.