MedicaidPrior AuthMedium impact
MAB2024111305
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Pediatrics, Family Medicine +3 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for stimulants and related agents (ADHD medications, sleep disorder drugs) effective January 6, 2025. Key changes include revised guidelines for non-preferred stimulants to consider therapeutically equivalent alternatives and removal of prescription drug monitoring program documentation requirements.
Action Required
By January 6, 2025: Update prior authorization workflows for Pennsylvania Medicaid stimulant prescriptions. Review new medical necessity guidelines for non-preferred stimulants, analeptic agents, and renewal requests. Train staff on updated documentation requirements - note that prescription drug monitoring program searches are no longer required to be documented. Update EMR templates and prior auth checklists to reflect new therapeutically equivalent brand/generic considerations for non-preferred agents.