MedicaidPrior AuthMedium impact
MAB2024110603
Pennsylvania Medicaid (DHS)·PA · Neurology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has updated prior authorization guidelines for migraine prevention agents, effective January 6, 2025. Key changes include revised requirements for therapeutic failure trials, new gepant approval pathways, and removal of restrictions on multiple gepant use.
Action Required
By January 6, 2025: Update prior authorization documentation processes for migraine prevention agents prescribed to Pennsylvania Medicaid patients. Ensure prescribing providers document therapeutic failure of at least one preventive drug from beta-blockers, antidepressants, or anticonvulsants classes. For gepants, document failure of at least two preferred CGRP monoclonal antibodies. Update clinical documentation templates to capture baseline migraine days per month and confirm specialist involvement (neurologist or UCNS-certified headache specialist).