January 26, 2026

To promote safe medication, use in older adults, new prior authorization criteria targeting specific anticholinergic medication has taken effect. This letter provides information about the POLY-ACH measure and outlines changes that may affect prescribing practices.

In CY2026, prior authorization is required for members aged 65 and older who accumulate more than 30 cumulative days’ supply of specified medications with anticholinergic effects:

The Use of Multiple Anticholinergic (ACH) Medications in Older Adults (POLY-ACH) Measure is in place to monitor performance on the percentage of Medicare members aged 65 and older who have concurrent use of multiple Anticholinergic medications, each with 2 or more fills. In this population, patients may experience Anticholinergic medication side effects due to reduction in drug clearance associated in older patients.

The above medications will require the following information to be submitted:

1. Confirmation of patient's diagnosis with chart notes.
2. The prescriber provides chart notes documenting the explanation of the risk versus benefit profile which shows the benefit outweighs the potential risk for the use of the high-risk medication.
3. The prescriber provides attestation of intent to monitor and address treatment-related adverse events.
4. If the patient is taking one or more additional anticholinergic medications (refer to the anticholinergic medication chart for reference) with the requested drug, the prescriber provides an explanation that taking multiple anticholinergic medications is medically necessary for the patient.
5. Trial of alternatives based on indication is included in several of the criteria. Prescribers must provide records of use and chart notes documenting treatment response, intolerance or contraindication to safer alternatives. Please refer to the individual criteria to determine appropriate alternatives based on medication.

For any inquiries, please contact our Pharmacy Department at 215-991-4300, available Monday through Friday 8:00 a.m. to 6:00 p.m. or the Provider Services Helpline at 1-888-991-9023, available Monday through Friday from 9:00 a.m. to 4:30 p.m.