MedicaidPrior AuthMedium impact
mab2025011002
Pennsylvania Medicaid (DHS)·PA · Neurology, Pediatrics, Pharmacy +3 more·Provider Bulletin
Effective date
Jan 15, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance has updated prior authorization requirements for anticonvulsant medications, specifically clarifying guidelines for Epidiolex (cannabidiol) that now require therapeutic failure of or contraindication to two anticonvulsants before approval. The policy also establishes specific prior authorization triggers for non-preferred anticonvulsants, quantity limit overrides, and clonazepam prescriptions under certain conditions.
Action Required
By January 15, 2025: Pharmacy and prescribing staff must implement new prior authorization workflows for anticonvulsant prescriptions including non-preferred drugs, quantity limit overrides, all Epidiolex prescriptions, and clonazepam for patients under 21 or with therapeutic duplication. Update prescription systems to flag these requirements and ensure documentation of therapeutic failures, contraindications, or intolerances for two anticonvulsants before prescribing Epidiolex. Failure to obtain prior authorization will result in claim denials.