MedicaidPrior AuthMedium impact
MAB2022120702
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Neurology, Pediatrics +4 more·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization requirements for stimulant medications effective January 9, 2023. Key changes include new guidelines for Evekeo when prescribed for obesity treatment and removal of automated prior authorization approvals.
Action Required
By January 9, 2023: Prescribing providers and pharmacy billing staff must review updated prior authorization requirements for stimulants and related agents. Update systems to reflect that Evekeo for obesity treatment now follows Obesity Treatment Agent guidelines, and automated prior authorizations are no longer available. Ensure all stimulant prescriptions for beneficiaries 18+ years old, non-preferred drugs, quantity limit exceeds, therapeutic duplications, and children under 4 have proper prior authorization. Claims without proper authorization will be denied.