MedicaidPrior AuthMedium impact
MAB2023110803
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Pediatrics, Family Medicine +3 more·Provider Bulletin
Effective date
Jan 8, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing new prior authorization guidelines for anxiolytic medications, including specific requirements for benzodiazepines prescribed to patients under 21 years old and new dose/duration guidelines. The policy also removes previous requirements for prescribers to document prescription drug monitoring program searches.
Action Required
By January 8, 2024: Billing and clinical teams must update prior authorization procedures for anxiolytic prescriptions under Pennsylvania Medicaid. Providers prescribing benzodiazepines to patients under 21 must ensure proper documentation of comprehensive evaluation and psychiatric consultation for severe acute anxiety cases. Update EMR templates to capture required medical necessity criteria including seizure disorders, chemotherapy-induced nausea, cerebral palsy, spastic disorders, dystonia, catatonia, or palliative care diagnoses. Staff should review the updated Prior Authorization of Pharmaceutical Services Handbook sections I and II for complete guidelines.