MedicaidPrior AuthMedium impact
MAB2024110706
Pennsylvania Medicaid (DHS)·PA · Neurology, Pain Management, Family 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 non-opioid barbiturate combination analgesics (like Fiorinal, Fioricet) effective January 6, 2025. The main changes are updated consensus guideline examples and removal of the requirement to document Prescription Drug Monitoring Program searches, but all other strict prior authorization criteria remain.
Action Required
By January 6, 2025: Billing and clinical teams must review updated prior authorization requirements for non-opioid barbiturate combination analgesics for Pennsylvania Medicaid patients. Update prior authorization request forms to reflect new consensus guideline examples and note that PDMP search documentation is no longer required. Ensure providers are aware they still must limit prescribing to maximum 3 days per month and meet all other strict clinical criteria including therapeutic failure of standard treatments and specific headache disorder classifications.