MedicaidPrior AuthMedium impact
MAB2024110704
Pennsylvania Medicaid (DHS)·PA · Pain Management, Neurology, Oncology +3 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for short-acting opioid analgesics, specifically adding new medical necessity guidelines for nasal butorphanol in migraine treatment. The updated guidelines include specific requirements for prescriber specialization and failed therapy documentation.
Action Required
Before January 6, 2025: Providers prescribing short-acting opioids to Pennsylvania Medicaid patients must review updated prior authorization requirements, especially for nasal butorphanol. Pain management specialists, neurologists, and headache specialists should update documentation templates to include required therapeutic failure history for migraine patients. Billing team should flag Pennsylvania Medicaid opioid prescriptions for prior auth review and ensure prescriber specialty certification is documented.