MedicaidPrior AuthHigh impact
2025.10 - Provider Bulletin - New Drug/Product Prior Authorization Form
Connecticut Medicaid (HUSKY Health)·CT·Prior Authorization
Effective date
Apr 1, 2025
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid has implemented a new Drug/Product Prior Authorization form effective April 1, 2025, which must be used for all early refill, brand medically necessary, non-preferred drug/product, and optimal dose requests. The new form requires additional documentation such as visit notes and chart documentation, and PA requests will be denied if the new form is not used or if required documentation is missing.
Action Required
By April 1, 2025: Prescribing providers must update EMR systems to use the new Drug/Product Prior Authorization form available at www.ctdssmap.com under the pharmacy information tab. Providers must submit all requested documentation including visit notes and chart documentation with PA requests. For denied PAs requiring medical necessity appeals, submit detailed letters with clinical documentation to Rx.LMN@ct.gov. Failure to use the new form or provide required documentation will result in PA denials.