MedicaidPrior AuthMedium impact
MAB2025110603
Pennsylvania Medicaid (DHS)·PA · Gastroenterology, Infectious Disease, Internal Medicine +2 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for antibiotics and GI medications, removing coverage for Xifaxan (rifaximin) due to manufacturer withdrawal from rebate program and Zinplava (bezlotoxumab) due to discontinuation. New medical necessity guidelines take effect January 5, 2026.
Action Required
Before January 5, 2026: Billing team must update prior authorization protocols for Pennsylvania Medicaid patients receiving antibiotics and GI medications. Stop billing for Xifaxan (rifaximin) as it's no longer covered. Review and implement new medical necessity guidelines for Dificid (fidaxomicin) requiring high-risk CDI factors or recurrent episodes. Update staff on new prior authorization requirements for non-preferred antibiotics and quantity limit exceeding prescriptions.