MedicaidPrior AuthMedium impact
MAB2025111002
Pennsylvania Medicaid (DHS)·PA · Neurology, Gastroenterology·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing updated prior authorization guidelines for Natalizumab (used to treat multiple sclerosis and Crohn's disease) effective January 5, 2026. The new guidelines require stricter step therapy protocols, particularly for Crohn's disease treatment, requiring failure of TNF inhibitors, IL-12/23 or IL-23 inhibitors, and vedolizumab before approval.
Action Required
By January 5, 2026: Providers treating multiple sclerosis and Crohn's disease patients must update prior authorization workflows for Natalizumab prescriptions. Ensure neurologists and gastroenterologists document required step therapy failures (TNF inhibitors, IL-12/23 or IL-23 inhibitors, and vedolizumab for Crohn's disease) and contraindications. Update EMR templates to include high-risk prognostic features documentation for Crohn's disease patients. All Natalizumab prescriptions will require prior authorization - failure to obtain approval will result in claim denials.