MedicaidPrior AuthMedium impact
MAB2022071103
Pennsylvania Medicaid (DHS)·PA · Cardiology, Family Medicine, Internal Medicine +2 more·Provider Bulletin
Effective date
Sep 1, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has updated prior authorization requirements for sympatholytic antihypertensive medications. The policy clarifies that non-preferred drugs and quantities exceeding limits require prior auth, with updated medical necessity guidelines requiring documentation of therapeutic failure or contraindications to preferred alternatives.
Action Required
By September 1, 2022: Billing and pharmacy teams must ensure prior authorization is obtained for all non-preferred sympatholytic antihypertensive medications and quantities exceeding limits for Pennsylvania Medicaid patients. Update workflow to verify preferred drug list status at https://papdl.com/preferred-drug-list and document therapeutic failure or contraindications to preferred alternatives. Claims will be denied without proper prior authorization.