MedicaidPrior AuthMedium impact
mab2024110806
Pennsylvania Medicaid (DHS)·PA · Neurology, Pain Management, PM&R (Physical Medicine & Rehab) +1 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing updated prior authorization requirements for all Botulinum Toxin prescriptions effective January 6, 2025. Key changes include revised guidelines for chronic spasticity (removing oral drug trial requirements for focal spasticity and pediatric patients), addition of CGRP therapies as acceptable prior treatments for chronic migraine, and new renewal documentation requirements including injection site mapping.
Action Required
By January 6, 2025: Update prior authorization workflows for Pennsylvania Medicaid Botulinum Toxin claims. Train clinical staff on new documentation requirements including injection site mapping and dosing details for renewals. Update EMR templates to capture CGRP therapy history for migraine patients and ensure spasticity criteria reflect new focal/pediatric exceptions. Verify prescriber specialization requirements for chronic migraine cases (neurologist or certified headache specialist).