MedicaidPrior AuthMedium impact
MAB2022111007
Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
Jan 9, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has updated prior authorization requirements for NSAIDs, adding new guidelines for topical NSAIDs, nasal ketorolac, and oral NSAID combination drugs. Prescribers must now document specific therapeutic failures or contraindications for non-preferred NSAIDs across different formulations.
Action Required
By January 9, 2023: Billing team must update prior authorization protocols for NSAID prescriptions. Ensure providers document therapeutic failure, contraindications, or intolerance to preferred NSAIDs before prescribing non-preferred options. Update encounter forms to include documentation requirements for topical NSAIDs, nasal ketorolac, and combination NSAID drugs. Train providers on new clinical reasons documentation for nasal ketorolac when oral ketorolac cannot be used.