MedicaidPrior AuthMedium impact
MAB2025111205
Pennsylvania Medicaid (DHS)·PA · Pulmonology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for COPD medications, specifically adding coverage guidelines for Dupixent (dupilumab) for COPD treatment. The policy clarifies when prior authorization is required for COPD agents including non-preferred drugs, quantity limits, and therapeutic duplications.
Action Required
By January 5, 2026: Billing team must update prior authorization protocols for Pennsylvania Medicaid COPD medication claims. Ensure providers are aware that Dupixent (dupilumab) now has specific prior authorization guidelines for COPD treatment. Update medication prior authorization checklists to include the new Dupixent requirements and review existing Daliresp (roflumilast) criteria. Pharmacies must follow updated guidelines or claims may be denied.