MedicaidPrior AuthMedium impact
MAB2024070201
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jul 15, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has updated prior authorization requirements for antidepressants, adding specific medical necessity guidelines for two new medications: Zulresso (brexanolone) and Zurzuvae (zuranolone), particularly for postpartum depression treatment.
Action Required
By July 15, 2024: Billing and clinical teams must update prior authorization processes for Pennsylvania Medicaid patients prescribed non-preferred antidepressants. Add documentation requirements for Zulresso and Zurzuvae prescriptions including validated depression rating scales (PHQ-9/EPDS, HAMD-17) for postpartum depression diagnoses. Update EMR templates to capture required clinical criteria including onset timing, severity scores, and contraindication checks. Failure to obtain proper prior authorization will result in claim denials.