MedicaidPrior AuthMedium impact
MAB2024110705
Pennsylvania Medicaid (DHS)·PA · Pain Management, Palliative Care, Oncology +2 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for long-acting opioid analgesics, creating special exemptions for buprenorphine products that no longer require documentation of short-acting opioid trials or opioid tolerance. All long-acting opioid prescriptions still require prior authorization with extensive clinical documentation including pain assessments, drug screening results, and risk evaluations.
Action Required
By January 6, 2025: Update prior authorization workflows for Pennsylvania Medicaid patients receiving long-acting opioid prescriptions. Train clinical staff that buprenorphine products no longer require documentation of short-acting opioid trials or opioid tolerance, while all other long-acting opioids still require this documentation. Ensure providers document all required elements including pain assessments, drug screening results, risk evaluations, and appropriate dosing before submitting prior authorization requests.