MedicaidPrior AuthMedium impact
mab2025011002
Pennsylvania Medicaid (DHS)·PA · Neurology, Pediatrics, Pharmacy +2 more·Provider Bulletin
Effective date
Jan 15, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance updated prior authorization requirements for anticonvulsant medications, specifically clarifying medical necessity guidelines for Epidiolex (cannabidiol). The changes affect pharmacy services for Medicaid beneficiaries and require providers to follow updated clinical review criteria when requesting prior authorization for certain anticonvulsants.
Action Required
By January 15, 2025: Providers prescribing anticonvulsants to Pennsylvania Medicaid patients must follow updated prior authorization guidelines. Review the revised medical necessity criteria for Epidiolex, ensuring documentation shows therapeutic failure of two anticonvulsants or diagnosis of specific seizure syndromes (Lennox-Gastaut, Dravet, or tuberous sclerosis complex). Update prior authorization request procedures to include new clinical review requirements for non-preferred anticonvulsants and clonazepam prescriptions.