MedicaidPrior AuthMedium impact
MAB2024110703
Pennsylvania Medicaid (DHS)·PA · Neurology, Pain Management, Family Medicine +1 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for neuropathic pain medications effective January 6, 2025. Key changes include clarified guidelines for postherpetic neuralgia and restless legs syndrome treatments, removal of prescription drug monitoring program documentation requirements, and new renewal criteria for non-preferred neuropathic pain agents.
Action Required
By January 6, 2025: Update prior authorization workflows for neuropathic pain medications including gabapentin extended-release and gabapentin enacarbil for Pennsylvania Medicaid patients. Ensure documentation includes therapeutic failure history of tricyclic antidepressants and immediate-release gabapentin for postherpetic neuralgia cases. Remove prescription drug monitoring program documentation requirements from prior auth requests. Update renewal processes to document positive clinical response for previously approved non-preferred agents.