MedicaidPrior AuthMedium impact
MAB2023063001
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Pain Management, Family Medicine +1 more·Provider Bulletin
Effective date
Jul 10, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for Opioid Use Disorder treatments, eliminating prior auth for oral buprenorphine without naloxone and removing several documentation requirements. The changes simplify access to addiction treatment medications while maintaining oversight for non-preferred drugs and high doses.
Action Required
By July 10, 2023: Update billing workflows to reflect that oral buprenorphine without naloxone no longer requires prior authorization for Pennsylvania Medicaid patients. Remove requirements for Prescription Drug Monitoring Program documentation and substance abuse counseling documentation for high-dose buprenorphine requests. Train staff that only non-preferred opioid use disorder treatments and quantities exceeding limits still require prior auth.