MedicaidPrior AuthMedium impact
MAB2023062901
Pennsylvania Medicaid (DHS)·PA · Family Medicine, Pediatrics, General Practice +4 more·Provider Bulletin
Effective date
Jul 10, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for antiemetic/antivertigo medications effective July 10, 2023. Non-preferred medications now require demonstrating failure of preferred drugs within the same mechanism of action and route of administration, and promethazine prescriptions for children under 6 require strict medical necessity criteria.
Action Required
By July 10, 2023: Billing and clinical staff must update prior authorization processes for antiemetic/antivertigo medications for Pennsylvania Medicaid patients. Verify preferred drug list status before prescribing non-preferred agents and ensure mechanism of action/route requirements are met. For promethazine in children under 6, document all required criteria including therapeutic failure of alternatives like ondansetron and risk of dehydration. Update EMR templates to capture required documentation elements.