MedicaidPrior AuthMedium impact
mab2024110702
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 has updated prior authorization requirements for non-preferred antidepressants, adding a new renewal guideline requiring documentation of therapeutic failure, contraindication, or intolerance to preferred therapeutically equivalent alternatives. The policy also includes specific criteria for specialized antidepressants like Zulresso, Zurzuvae, and Spravato.
Action Required
By January 6, 2025: Prescribers and billing teams must update prior authorization processes for Pennsylvania Medicaid patients receiving non-preferred antidepressants. For renewals, document therapeutic failure, contraindication, or intolerance to preferred therapeutically equivalent alternatives. Update EMR templates to capture required clinical criteria including depression rating scales for postpartum depression, psychiatric consultation requirements for Spravato, and dosing consistency with FDA labeling. Review current patients on non-preferred antidepressants to ensure compliance with new renewal requirements.