MedicaidPrior AuthMedium impact
MAB2022110401
Pennsylvania Medicaid (DHS)·PA · Dermatology, Family Medicine, General Practice +2 more·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for all oral acne medications (isotretinoin, etc.) starting January 9, 2023. Prescriptions must show therapeutic failure of oral antibiotics, topical antibiotics, AND topical retinoids before approval, and must be prescribed by or in consultation with a dermatologist.
Action Required
By January 9, 2023: Billing team must update system to require prior authorization for all oral acne agents for Pennsylvania Medicaid patients. Providers must document therapeutic failure of oral antibiotics, topical antibiotics, and topical retinoids, plus ensure dermatologist involvement before prescribing. Update encounter forms and EMR templates to capture required documentation. Claims will be denied without prior authorization.