MedicaidPrior AuthMedium impact
MAB2023110801
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 8, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for non-preferred antidepressants and adding new guidelines for Spravato (esketamine) effective January 8, 2024. The changes require prescribers to demonstrate therapeutic failures with preferred options and meet specific clinical criteria for approval.
Action Required
Before January 8, 2024: Providers prescribing antidepressants to Pennsylvania Medicaid patients must update documentation templates to include therapeutic failure history, contraindications, and trial durations of at least 6 weeks for preferred medications. For Spravato prescriptions, ensure psychiatrist consultation is documented and oral antidepressant combination therapy is noted. Update prior authorization request procedures to include new clinical criteria requirements.