MedicaidPrior AuthMedium impact
MAB2023110905
Pennsylvania Medicaid (DHS)·PA · Neurology, Family Medicine, Internal Medicine·Provider Bulletin
Effective date
Jan 8, 2024
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization requirements for migraine prevention agents effective January 8, 2024. The new guidelines clarify that existing requirements for Nurtec ODT now apply to all preferred gepant medications for migraine prevention.
Action Required
By January 8, 2024: Providers prescribing migraine prevention agents to Pennsylvania Medicaid patients must ensure all prior authorization requests meet updated guidelines. Verify that requests for preferred gepant medications (like Nurtec ODT) include documentation of therapeutic failure or contraindications to preferred CGRP monoclonal antibodies. Update prior authorization request templates to reflect these requirements. Claims without proper prior authorization will be denied.