MedicaidPrior AuthMedium impact
MAB2025111003
Pennsylvania Medicaid (DHS)·PA · Neurology, Pharmacy·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for Multiple Sclerosis agents, adding Ocrevus Zunovo to the prior auth list and revising guidelines for non-preferred MS drugs and renewal criteria. The changes affect prescribing and billing for MS medications under Pennsylvania's Medical Assistance program.
Action Required
By January 5, 2026: Billing team must update prior authorization procedures for Multiple Sclerosis agents in Pennsylvania Medicaid cases. Add Ocrevus Zunovo (ocrelizumab and hyaluronidase-ocsq) to the list of drugs requiring prior auth. Update workflows to ensure neurologist prescribing requirements are met and therapeutic failure documentation is provided for non-preferred MS agents. Review quantity limits and renewal guidelines for existing MS drug authorizations.