MedicaidPrior AuthMedium impact
MAB2024110703
Pennsylvania Medicaid (DHS)·PA · Pain Management, Neurology, Family Medicine +1 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization requirements for neuropathic pain medications effective January 6, 2025. The changes clarify guidelines for extended-release gabapentin, remove some restless leg syndrome requirements, and add new renewal criteria for non-preferred neuropathic pain agents.
Action Required
By January 6, 2025: Billing and clinical teams must update prior authorization procedures for neuropathic pain medications for Pennsylvania Medicaid patients. Review updated guidelines for gabapentin extended-release and gabapentin enacarbil extended-release requiring documentation of tricyclic antidepressant failure and immediate-release gabapentin failure. Update EMR templates to capture required clinical documentation for postherpetic neuralgia and restless legs syndrome treatments. Remove previous pramipexole/ropinirole failure requirements for restless legs syndrome. Implement new renewal documentation requirements for non-preferred agents showing positive clinical response.