MedicaidPrior AuthMedium impact
mab2024110804
Pennsylvania Medicaid (DHS)·PA · Neurology, Family Medicine, Internal Medicine +2 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization requirements for Antiparkinson's agents effective January 6, 2025. The key change is that therapeutically equivalent brands and generics will now be considered when evaluating requests for non-preferred Antiparkinson's medications.
Action Required
By January 6, 2025: Billing and prior authorization staff must update procedures for Antiparkinson's agent prior authorizations for Pennsylvania Medicaid patients. Note that non-preferred brands will no longer automatically qualify for prior auth if a therapeutically equivalent generic is preferred (and vice versa). Review the updated Preferred Drug List at papdl.com and update prior authorization request templates to reflect new therapeutic equivalency considerations. Providers must document therapeutic failure, contraindication, or intolerance to preferred agents, or show current use within past 90 days of the same non-preferred agent.