MedicaidPrior AuthMedium impact
MAB2022110803
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Pediatrics, Neurology +1 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 antipsychotic medications, effective January 9, 2023. Key changes include removal of Invega guidelines and revised requirements for children under 18, including stricter specialist consultation rules and comprehensive monitoring requirements.
Action Required
By January 9, 2023: Providers prescribing antipsychotics to PA Medicaid patients must update prior authorization procedures. For children under 14, ensure prescriptions are by or in consultation with pediatric neurologist, child psychiatrist, or child development pediatrician only. For ages 14-17, add general psychiatrist as acceptable specialist. Update documentation requirements to include comprehensive evaluation, non-pharmacologic therapy plans, and baseline monitoring (BMI, blood pressure, glucose/A1c, lipids, AIMS scale). Pharmacy staff must follow new guidelines for therapeutic duplication and quantity limit reviews.