MedicaidPrior AuthMedium impact
mab2024110702
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization guidelines for non-preferred antidepressants, specifically adding new requirements for renewal requests when a therapeutically equivalent preferred drug exists on the Preferred Drug List. The updated medical necessity criteria will apply to both fee-for-service and managed care Medicaid plans.
Action Required
Before January 6, 2025: Providers prescribing non-preferred antidepressants to Pennsylvania Medicaid patients must review updated prior authorization renewal requirements. When renewing authorization for non-preferred antidepressants that have therapeutically equivalent preferred alternatives, document history of therapeutic failure, contraindication, or intolerance to the preferred equivalent. Billing team should update prior authorization tracking system to flag renewal requests requiring additional documentation. Failure to meet new guidelines may result in denial of renewal requests.