MedicaidPrior AuthMedium impact
MAB2024111201
Pennsylvania Medicaid (DHS)·PA · Hematology, Oncology, Transplant Surgery·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing updated prior authorization requirements for Colony Stimulating Factors (medications that boost white blood cell production). New guidelines require prescriptions to be written by specialists, follow FDA-approved dosing, and meet specific clinical criteria for approval.
Action Required
Before January 6, 2025: Providers prescribing Colony Stimulating Factors for Pennsylvania Medicaid patients must ensure all prescriptions meet new prior authorization criteria including specialist consultation requirements, FDA-approved dosing, and specific clinical guidelines for febrile neutropenia prophylaxis. Update prior authorization request procedures to include new documentation requirements. Non-compliance will result in prescription denials.