MedicaidPrior AuthMedium impact
MAB2025111302
Pennsylvania Medicaid (DHS)·PA · Dermatology, Pulmonology, Allergy & Immunology +3 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing updated prior authorization requirements for Dupixent (dupilumab) effective January 5, 2026. The changes clarify existing guidelines for atopic dermatitis treatment and add new requirements for bullous pemphigoid indications.
Action Required
Before January 5, 2026: Billing team and providers must review updated Dupixent prior authorization requirements. Ensure documentation includes specialist consultation, previous therapy failures, and condition-specific criteria (body surface area >10% for atopic dermatitis, blood eosinophil count ≥150 for asthma, new bullous pemphigoid guidelines). Update prior authorization request templates to include all required clinical elements. Claims without proper prior authorization will be denied.