MedicaidPrior AuthMedium impact
MAB2023062803
Pennsylvania Medicaid (DHS)·PA · Pain Management, Family Medicine, Internal Medicine +3 more·Provider Bulletin
Effective date
Jul 10, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for short-acting opioid pain medications, removing some requirements for patients 18-20 years old taking codeine/tramadol and modifying documentation requirements for all age groups. The changes streamline the approval process while maintaining safety protocols.
Action Required
By July 10, 2023: Prescribers and billing staff must update prior authorization procedures for short-acting opioid analgesics per the new guidelines. Review the updated Medical Assistance handbook pages for specific documentation requirements. Ensure staff understand that codeine/tramadol no longer requires prior auth for patients 18-20 years old, and approval durations can now be up to 6 months for all requests.