MedicaidPrior AuthMedium impact
MAB2021121602
Pennsylvania Medicaid (DHS)·PA · Neurology, Psychiatry, Pediatrics +2 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for anticonvulsants effective January 3, 2022. Key changes include clarifying that current prescription history doesn't apply when switching between preferred generic/brand equivalents, and adding catatonia as an approved diagnosis for clonazepam in patients under 21.
Action Required
By January 3, 2022: Billing and clinical teams must update prior authorization procedures for anticonvulsant prescriptions. For non-preferred anticonvulsants, ensure documentation shows therapeutic failure cannot rely on current prescription history when switching between therapeutically equivalent generic/brand forms. For clonazepam patients under 21, add catatonia to approved diagnosis list alongside seizure disorder, chemotherapy-induced nausea/vomiting, cerebral palsy, spastic disorder, and dystonia. Update EMR templates to reflect new criteria.