MedicaidPrior AuthMedium impact
MAB2024110704
Pennsylvania Medicaid (DHS)·PA · Pain Management, Neurology, Oncology +4 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 short-acting opioid analgesics, specifically adding new guidelines for nasal butorphanol when used for migraine treatment. The policy maintains existing prior authorization triggers but expands medical necessity criteria for certain specialist-prescribed opioid medications.
Action Required
Before January 6, 2025: Billing and clinical teams must update prior authorization procedures for short-acting opioid prescriptions for Pennsylvania Medicaid patients. Ensure documentation includes specialist certification requirements for nasal butorphanol (neurologist or headache specialist certified in headache medicine) and failure history of specified abortive and preventive migraine therapies. Update EMR templates to capture required medical necessity elements. Failure to provide proper documentation will result in prior authorization denials.