MedicaidPrior AuthMedium impact
MAB2025110606
Pennsylvania Medicaid (DHS)·PA · Urology, Family Medicine, Internal Medicine·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing new prior authorization requirements for BPH (benign prostatic hyperplasia) treatments, including specific guidelines for non-preferred drugs, phosphodiesterase type 5 inhibitors, and therapeutic duplications. Pharmacies and prescribers must follow updated medical necessity criteria when requesting prior authorization for BPH medications.
Action Required
Before January 5, 2026: Providers prescribing BPH treatments must ensure prior authorization requests include documentation of therapeutic failure or contraindications for non-preferred drugs, confirm BPH diagnosis and appropriate dosing for phosphodiesterase type 5 inhibitors (e.g., tadalafil), and provide medical justification for therapeutic duplications. Update EMR templates to capture required medical necessity criteria. Billing team should verify preferred drug list status at https://papdl.com/preferred-drug-list before prescribing.