MedicaidPrior AuthMedium impact
MAB2022071104
Pennsylvania Medicaid (DHS)·PA · Dermatology, Family Medicine, General Practice +3 more·Provider Bulletin
Effective date
Sep 1, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for non-preferred topical antibiotics, effective September 1, 2022. The medical necessity guidelines were revised for clarity but the actual requirements remain unchanged - prescribers must still demonstrate therapeutic failure, contraindication, or intolerance to preferred topical antibiotics.
Action Required
By September 1, 2022: Billing and clinical staff must ensure prior authorization requests for non-preferred topical antibiotics include documentation of therapeutic failure, contraindication, or intolerance to preferred topical antibiotics. Review the updated Pennsylvania Medicaid Preferred Drug List to identify which topical antibiotics require prior authorization. Update prior authorization request templates to include required clinical information.