MedicaidPrior AuthMedium impact
MAB2022071301
Pennsylvania Medicaid (DHS)·PA · OB-GYN, Family Medicine, General Practice +1 more·Provider Bulletin
Effective date
Sep 1, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is updating prior authorization requirements for non-preferred oral contraceptives, with revised medical necessity guidelines for clarity. The clinical criteria remain the same - prior auth is required for non-preferred oral contraceptives unless the patient has therapeutic failure, contraindication, or intolerance to preferred options.
Action Required
By September 1, 2022: Billing and pharmacy teams must review the updated Prior Authorization of Pharmaceutical Services Handbook for oral contraceptives. Ensure prior authorization is obtained for all non-preferred oral contraceptives per the Preferred Drug List (PDL) at papdl.com. Update documentation requirements to include history of therapeutic failure, contraindication, or intolerance to preferred contraceptives when requesting prior auth for non-preferred options.