[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-563974-105":53,"doc-detail-563974-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","subject-coverage-change-and-prior-authorization-of-glp-1-receptor-agonists","SUBJECT - Coverage Change and Prior Authorization of GLP-1 Receptor Agonists","","Coverage Change and Prior Authorization bulletin addresses the Pennsylvania Medical Assistance (MA) Program’s updates for GLP-1 receptor agonist drugs. Effective January 1, 2026, coverage ends for GLP-1 receptor agonists used to treat overweight and obesity, and prior authorizations must be renewed through new requests for all affected beneficiaries. Coverage continues for other medically accepted indications with prior authorization. It also adds a GLP-1 Receptor Agonists therapeutic class to the Statewide Preferred Drug List and updates handbook requirements for medical-necessity review.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/subject-coverage-change-and-prior-authorization-of-glp-1-receptor-agonists/563974/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/subject-coverage-change-and-prior-authorization-of-glp-1-receptor-agonists/563974.png","ImageObject",442,249,{"name":88,"@type":89},"Jake","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-18","2026-10-12",true,{"@type":98,"interactionType":99,"userInteractionCount":9},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What changes effective January 1, 2026 for GLP-1 receptor agonists in the MA program?","Question",{"text":108,"@type":109},"Coverage ends for drugs containing a GLP-1 receptor agonist when used to treat overweight and obesity. For all beneficiaries receiving a GLP-1 receptor agonist, providers must submit new prior authorization requests effective January 1, 2026.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Are prior authorizations issued before January 1, 2026 still valid?",{"text":113,"@type":109},"No. Current prior authorizations for drugs containing a GLP-1 receptor agonist are no longer valid after December 31, 2025, regardless of the condition being treated.",{"name":115,"@type":106,"acceptedAnswer":116},"What coverage remains available for GLP-1 receptor agonists after the change?",{"text":117,"@type":109},"GLP-1 receptor agonist drugs continue to be covered for all other medically accepted indications with a prior authorization. Drugs designated as preferred within the Obesity Treatment Agents class remain available without prior authorization as long as quantity and daily dose limits are not exceeded.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},563974,1792352154,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":9,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":25,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":47},962084928904,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","SUBJECT  \nCoverage Change and Prior Authorization of GLP-1 Receptor Agonists (Formerly Hypoglycemics, Incretin Mimetics/Enhancers and Obesity Treatment Agents)– Pharmacy Services  \nBY   \nSally Kozak  \nDeputy Secretary  \nOffice of Medical Assistance Programs  \nIMPORTANT REMINDER: All providers must revalidate the Medical Assistance (MA) enrollment of each service location every 5 years. Providers should log into PROMISe to check the revalidation dates of each service location and submit revalidation applications at least 60 days prior to the revalidation dates. Enrollment (revalidation) applications may be found at: [https://www.pa.gov/en/agencies/dhs/resources/for](https://www.pa.gov/en/agencies/dhs/resources/for)  \nproviders/provider-enrollment-information/provider-enrollment-documents  \nPURPOSE:  \nThe purpose of this bulletin is to:  \n1. Inform providers that effective January 1, 2026, coverage will end for drugs containing a glucagon-like peptide-1 (GLP-1) receptor agonist for the treatment of overweight and obesity for Medical Assistance (MA) beneficiaries.  \n2. Inform providers that Obesity Treatment Agents that do not contain a GLP-1 listed on the Department of Human Services (Department) Statewide Preferred Drug List (PDL) will remain a compensable service for MA beneficiaries.  \n3. Inform providers of the addition of the GLP-1 Receptor Agonists therapeutic class to the Statewide PDL.  \n4. Inform providers that drugs containing a GLP-1 receptor agonist will continue to be covered for conditions other than overweight and obesity with a prior authorization.  \n5. Issue updated handbook pages that include the requirements for prior authorization and the type of information needed to evaluate the medical necessity of prescriptions for GLP-1 Receptor Agonists submitted for prior authorization.  \nSCOPE:  \nThis bulletin applies to all licensed pharmacies and prescribers enrolled in the MA  \n*01-26-37 09-26-37 27-26-37 33-26-37  \n02-26-37 11-26-37 30-26-37  \n03-26-37 14-26-37 31-26-37  \n08-26-37 24-26-37 32-26-37  \nProgram. The guidelines to determine the medical necessity of GLP-1 Receptor Agonists will be utilized in the fee-for-service and managed care delivery systems. Providers rendering services to MA beneficiaries in the managed care delivery system should address any questions related to the prior authorization of GLP-1 Receptor Agonists to the appropriate managed care organization.  \nBACKGROUND/DISCUSSION:  \nGLP-1 receptor agonists are used to treat diabetes and have been covered by the MA Program since their introduction to the market in 2005. Recently, drugs containing GLP-1 receptor agonists have been approved by the U.S. Food and Drug Administration (FDA) to treat overweight, obesity, obstructive sleep apnea, noncirrhotic metabolic dysfunctionassociated steatohepatitis with moderate to advanced liver fibrosis and to reduce cardiovascular risk in patients who have had a heart attack or stroke or have peripheral arterial disease.  \nThe MA Program began covering drugs containing a GLP-1 receptor agonist to treat overweight and obesity in January 2023 for MA beneficiaries who meet the prior authorization guidelines. Coverage of drugs for weight loss is an optional benefit for Medicaid programs. See 42 U.S.C. § 1396r-8(d)(2)(A) . The MA Program will discontinue coverage for drugs containing a GLP-1 receptor agonists for the treatment of overweight and obesity for MA beneficiaries.  \nEffective January 1, 2026, drugs containing a GLP-1 receptor agonist will not be covered for the treatment of overweight and obesity. Drugs containing a GLP-1 receptor agonist will continue to be covered for all other medically accepted indications with a prior authorization. Saxenda (liraglutide) will no longer be covered for any indication.  \nObesity Treatment Agents that do not contain a GLP-1 receptor agonist will continue tobe covered by the MA Program. Drugs that are designated as preferred in the Obesity Treatment Agents Statewide PDL ","cbCaihSf1VW34EXY","https://ap.wps.com/l/cbCaihSf1VW34EXY","pdf",768321,"English","# PURPOSE\n# SCOPE\n# BACKGROUND/DISCUSSION\n# PROCEDURE\n# ATTACHMENTS\n# RESOURCES","[{\"question\":\"What changes effective January 1, 2026 for GLP-1 receptor agonists in the MA program?\",\"answer\":\"Coverage ends for drugs containing a GLP-1 receptor agonist when used to treat overweight and obesity. For all beneficiaries receiving a GLP-1 receptor agonist, providers must submit new prior authorization requests effective January 1, 2026.\"},{\"question\":\"Are prior authorizations issued before January 1, 2026 still valid?\",\"answer\":\"No. Current prior authorizations for drugs containing a GLP-1 receptor agonist are no longer valid after December 31, 2025, regardless of the condition being treated.\"},{\"question\":\"What coverage remains available for GLP-1 receptor agonists after the change?\",\"answer\":\"GLP-1 receptor agonist drugs continue to be covered for all other medically accepted indications with a prior authorization. Drugs designated as preferred within the Obesity Treatment Agents class remain available without prior authorization as long as quantity and daily dose limits are not exceeded.\"}]","SUBJECT - Coverage Change and Prior Authorization of GLP-1 Receptor Agonists | PDF",1791839631]