MedicaidPrior AuthMedium impact
MAB2024110701
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 requirements for SSRI antidepressants, now considering therapeutically equivalent brands and generics when evaluating non-preferred drug requests. The clinical review guidelines remain the same except for this equivalency consideration.
Action Required
By January 6, 2025: Billing team and providers must update prior authorization procedures for SSRI antidepressants for Pennsylvania Medicaid patients. When requesting prior auth for non-preferred SSRIs, document that therapeutically equivalent preferred options (brands or generics) have been tried, contraindicated, or not tolerated. Update clinical documentation templates to capture therapeutic equivalency history.