MedicaidPrior AuthMedium impact
MAB2024110606
Pennsylvania Medicaid (DHS)·PA · Neurology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 6, 2025
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing new prior authorization requirements for migraine acute treatment agents including gepants, ditans, and ergot alkaloids. The policy adds specific criteria for non-preferred gepants and new renewal requirements for prior authorizations.
Action Required
By January 6, 2025: Billing team must update prior authorization procedures for migraine medications prescribed to Pennsylvania Medicaid patients. Ensure all non-preferred gepants, ditans, ergot alkaloids, and quantities exceeding limits have proper prior authorization before dispensing. Update pharmacy and prescriber workflows to document therapeutic failures of preferred triptans and contraindications as required. Claims without proper prior authorization will be denied.