MedicaidPrior AuthMedium impact
MAB2023062904
Pennsylvania Medicaid (DHS)·PA · Pharmacy·Provider Bulletin
Effective date
Jul 10, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for compounded prescriptions, clarifying medical necessity guidelines and review processes. All compounded prescriptions continue to require prior authorization with clearer documentation requirements for clinical rationale and peer-reviewed literature support.
Action Required
By July 10, 2023: Billing team must ensure all compounded prescription prior authorization requests include clinical rationale for using compounded product instead of FDA-approved alternatives and peer-reviewed medical literature supporting the indication. Update prior authorization request templates to include these required documentation elements. Requests without proper documentation will be denied or referred for physician review.