MedicaidPrior AuthMedium impact
MAB2023062802
Pennsylvania Medicaid (DHS)·PA · Pain Management, Family Medicine, Internal Medicine +2 more·Provider Bulletin
Effective date
Jul 10, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has revised prior authorization requirements for long-acting opioid analgesics, removing several documentation requirements while adding specific guidelines for pediatric patients and simplifying the approval process. The changes streamline authorization while maintaining safety protocols.
Action Required
By July 10, 2023: Providers prescribing long-acting opioids to Pennsylvania Medicaid patients must update their prior authorization request processes. Remove requirements for documenting anticipated therapy duration, patient education about adverse effects, and PDMP searches from requests. Add specific pediatric dosing restrictions (no codeine or tramadol for under 18). Update clinical workflows to reflect simplified renewal criteria and new 1-month approval options for ongoing therapy patients.