MedicaidPrior AuthMedium impact
MAB2023110901
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Neurology, 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 requirements for sedative hypnotics effective January 8, 2024. The policy adds prior auth requirements for therapeutic duplications of non-benzodiazepine sedatives and removes prescription drug monitoring documentation requirements.
Action Required
By January 8, 2024: Billing team must update prior authorization procedures for Pennsylvania Medicaid patients receiving sedative hypnotics. Train staff on new therapeutic duplication requirements for non-benzodiazepine sedatives. Review the updated Prior Authorization of Pharmaceutical Services Handbook Section II guidelines. Ensure prescribers are aware that prior auth is now required when there's a recent paid claim for another non-benzodiazepine sedative hypnotic. Claims may be denied without proper prior authorization.