MedicaidPrior AuthMedium impact
MAB2025111405
Pennsylvania Medicaid (DHS)·PA · Neurology, Family Medicine, Internal Medicine +3 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing new prior authorization requirements for migraine acute treatment medications (triptans, gepants, ditans, ergot alkaloids, and NSAIDs) effective January 5, 2026. The policy adds specific criteria for non-preferred combination products and NSAIDs, requiring documentation of therapeutic failure or contraindications to preferred medications.
Action Required
Before January 5, 2026: Providers prescribing migraine medications to Pennsylvania Medicaid patients must update prior authorization workflows. Document therapeutic failure, contraindications, or intolerances to preferred triptans before prescribing non-preferred migraine medications. Ensure diagnosis follows International Headache Society Classification. Pharmacy staff must verify prior authorization for all non-preferred migraine agents, quantity limit overrides, and therapeutic duplications.