MedicaidPrior AuthMedium impact
MAB2022032202
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Sleep Medicine, Pain Management +5 more·Provider Bulletin
Effective date
Apr 1, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for sedative hypnotics, removing the requirement that patients be totally blind for non-24-hour sleep-wake disorder diagnosis. The policy clarifies when prior authorization is needed for benzodiazepines and other sedative hypnotics, including specific restrictions for patients under 21 and those on buprenorphine.
Action Required
By April 1, 2022: Billing and clinical teams must update prior authorization protocols for sedative hypnotics prescriptions. Remove total blindness requirement for non-24-hour sleep-wake disorder approvals. Ensure prior auth requests for benzodiazepines in patients under 21, therapeutic duplications, and concurrent buprenorphine use include proper medical necessity documentation. Update workflow to check PDMP for controlled substances.