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 Fioricet), removing the requirement to document prescription drug monitoring program searches while keeping all other strict criteria including headache diagnosis requirements and frequency limits.
Action Required
By January 6, 2025: Pharmacy and prescribing staff must update prior authorization documentation procedures for non-opioid barbiturate combinations (Fioricet, etc.) for Pennsylvania Medicaid patients. Remove prescription drug monitoring program search documentation requirement from workflows, but ensure all other criteria are met including headache diagnosis, frequency limits (max 3 days per month), and failure of standard treatments. Update prior authorization request templates accordingly.