MedicaidPrior AuthMedium impact
MAB2025110602
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for 'Other Antidepressants' effective January 5, 2026. The key change removes the requirement that Spravato (esketamine) must be prescribed in conjunction with oral antidepressants, allowing it to be used as monotherapy when other criteria are met.
Action Required
By January 5, 2026: Billing team must update prior authorization procedures for Other Antidepressants in Pennsylvania Medicaid cases. Remove the requirement for concurrent oral antidepressant therapy when requesting Spravato (esketamine) prior authorization. Update clinical staff and providers that Spravato can now be prescribed as monotherapy if other medical necessity criteria are met. Review current Spravato patients to determine if simplified prior auth renewals may apply.