MedicaidPrior AuthHigh impact
MAB2025110605
Pennsylvania Medicaid (DHS)·PA · Pain Management, Family Medicine, Internal Medicine +3 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid will require prior authorization for all analgesic acute pain medications starting January 5, 2026. Prescribers must demonstrate failure or contraindication to acetaminophen and NSAIDs before approval, with special restrictions on the new drug Journavx (suzetrigine).
Action Required
By January 5, 2026: Billing and clinical teams must implement prior authorization processes for all analgesic acute pain medications for Pennsylvania Medicaid patients. Update EMR templates to document therapeutic failure or contraindications to acetaminophen and NSAIDs. Train providers on new requirements including 14-day supply limits for Journavx (suzetrigine). Prescriptions without prior authorization will be denied at the pharmacy level.