MedicaidPrior AuthMedium impact
MAB2024110701
Pennsylvania Medicaid (DHS)·PA · Psychiatry, 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 SSRI antidepressants, effective January 6, 2025. The main change is that therapeutically equivalent brands and generics will now be considered when evaluating requests for non-preferred SSRIs, with no other changes to medical necessity guidelines.
Action Required
Before January 6, 2025: Pharmacy and prescribing staff must review updated prior authorization guidelines for SSRI antidepressants for Pennsylvania Medicaid patients. Update prior authorization request procedures to account for therapeutically equivalent brands and generics when requesting non-preferred SSRIs. Review the updated Preferred Drug List at papdl.com and clinical guidelines at the PA DHS website. Ensure staff understand that non-preferred SSRIs, quantities exceeding limits, and therapeutic duplications still require prior authorization.