MedicaidPrior AuthMedium impact
MAB2025111202
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Neurology, Pediatrics +3 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization requirements for stimulant medications, adding a new requirement that prescriptions must be for FDA-approved or medically accepted indications. The policy takes effect January 5, 2026, with no other changes to existing medical necessity guidelines.
Action Required
Before January 5, 2026: Billing team must update prior authorization procedures for stimulant medications to ensure prescriptions include documentation of FDA-approved or medically accepted indications. Providers must be notified to document appropriate indications when prescribing stimulants for Pennsylvania Medicaid patients. Claims without proper indication documentation may be denied.