MedicaidPrior AuthMedium impact
MAB2025111005
Pennsylvania Medicaid (DHS)·PA · Cardiology, Endocrinology, Family Medicine +3 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing new prior authorization requirements for lipotropic and statin medications effective January 5, 2026. Non-preferred statins, quantities exceeding limits, and therapeutic duplications will require prior authorization with specific medical necessity criteria.
Action Required
Before January 5, 2026: Billing team must update Pennsylvania Medicaid prior authorization workflows for lipotropic and statin prescriptions. Train providers on new medical necessity criteria for non-preferred statins and combination products. Update pharmacy billing systems to flag therapeutic duplications and quantity limit overages. Review the updated Preferred Drug List at https://papdl.com/preferred-drug-list for current preferred statins.