MedicaidPrior AuthMedium impact
MAB2023062902
Pennsylvania Medicaid (DHS)·PA · Family Medicine, Pediatrics, Internal Medicine +2 more·Provider Bulletin
Effective date
Jul 10, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing new prior authorization requirements for cough and cold medications, particularly those containing opioids for pediatric patients and patients receiving opioid use disorder treatment. The policy clarifies age restrictions and adds safety requirements for promethazine-containing medications.
Action Required
By July 10, 2023: Update prior authorization workflows to require approval for all cough and cold medications prescribed to patients under 6 years old, opioid-containing cough medications for patients 6-17 years old, and any cough/cold medications for patients on buprenorphine or Vivitrol. Train staff to verify concurrent prescriptions and document medical necessity including therapeutic failures of alternatives. Claims will be denied without proper prior authorization.