MedicaidPrior AuthMedium impact
MAB2024111305
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Neurology, Pediatrics +3 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for stimulants and related agents effective January 6, 2025. Key changes include revised guidelines for non-preferred stimulants to consider therapeutically equivalent alternatives, removal of prescription drug monitoring program documentation requirements, and updated renewal guidelines for both standard and analeptic stimulant agents.
Action Required
By January 6, 2025: Review updated prior authorization guidelines for stimulant prescriptions in Pennsylvania Medicaid patients. Update workflows to ensure compliance with new medical necessity criteria, particularly for non-preferred stimulants, analeptic agents, and patients under 4 or over 18 years old. Remove requirements for prescription drug monitoring program documentation searches. Access updated handbook pages at the provided PA.gov resources.