MedicaidPrior AuthMedium impact
MAB2022032201
Pennsylvania Medicaid (DHS)·PA · Neurology, Psychiatry, Pain Management +3 more·Provider Bulletin
Effective date
Apr 1, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for anticonvulsant medications, including revised medical necessity guidelines for non-preferred anticonvulsants and updated requirements for clonazepam prescriptions. The changes also remove prior authorization requirements for gabapentinoids when used for therapeutic duplication.
Action Required
Before April 1, 2022: Review anticonvulsant prescribing patterns for Pennsylvania Medicaid patients. Update prior authorization procedures to reflect new medical necessity guidelines requiring failure of two preferred anticonvulsants for seizure disorders and all preferred anticonvulsants for other diagnoses. Train clinical staff on updated clonazepam restrictions for patients under 21 and those on buprenorphine. Remove prior authorization requirements for gabapentinoid duplications as these are now handled under Neuropathic Pain Agents guidelines.