MedicaidPrior AuthMedium impact
mab2024110801
Pennsylvania Medicaid (DHS)·PA · Neurology, Pediatrics, Psychiatry +2 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing new prior authorization requirements for anticonvulsant medications, including new requirements for Epidiolex (cannabidiol) and updated guidelines for clonazepam prescriptions. The policy removes previous prescription drug monitoring program search requirements and adds automated prior authorization options.
Action Required
By January 6, 2025: Billing team must update prior authorization workflows for Pennsylvania Medicaid patients receiving anticonvulsant medications. Key changes: (1) All Epidiolex (cannabidiol) prescriptions now require prior auth, (2) Clonazepam prescriptions for patients under 21 require prior auth with specific diagnosis documentation, (3) Enhanced prior auth requirements for clonazepam when used with other benzodiazepines or buprenorphine. Update billing system flags and notify prescribers of new documentation requirements to prevent claim denials.