MedicaidPrior AuthMedium impact
MAB2021121601
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Neurology, Pediatrics +3 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization requirements for sedative hypnotic medications, including benzodiazepines, effective January 3, 2022. The key change adds catatonia as an approved diagnosis for benzodiazepine use in patients under 21 years old, aligning with 2020 American Academy of Pediatrics guidelines.
Action Required
By January 3, 2022: Providers prescribing sedative hypnotics (including benzodiazepines) for Pennsylvania Medicaid patients must ensure proper prior authorization documentation. Update clinical protocols to include catatonia as an approved diagnosis for benzodiazepine prescriptions in patients under 21. Verify prescribers conduct Pennsylvania PDMP searches for controlled substance prescriptions. Non-compliance will result in claim denials for sedative hypnotic medications requiring prior authorization.