MedicaidPrior AuthMedium impact
mab2024110804
Pennsylvania Medicaid (DHS)·PA · Neurology, Family Medicine, Internal Medicine +2 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for Antiparkinson's agents effective January 6, 2025. The key change is that therapeutically equivalent brands and generics will now be considered when evaluating requests for non-preferred Antiparkinson's agents, meaning switching between equivalent formulations may require new prior authorization.
Action Required
By January 6, 2025: Billing team must update prior authorization workflows for Antiparkinson's agents for Pennsylvania Medicaid patients. Verify preferred drug list status at https://papdl.com/preferred-drug-list before prescribing. Non-preferred agents now require documentation of therapeutic failure, contraindication, or intolerance to preferred equivalent brands/generics, or current 90-day history of the same non-preferred agent. Update encounter forms to remind providers of new equivalency requirements.