MedicaidPrior AuthMedium impact
MAB2021110403
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Pediatrics, Neurology +1 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for antipsychotic medications, effective January 3, 2022. Key changes include removing prior auth requirements for low-dose antipsychotics, clarifying brand vs. generic equivalency rules, and updating therapeutic duplication guidelines.
Action Required
By January 3, 2022: Billing and pharmacy teams must update prior authorization workflows for antipsychotic medications in Pennsylvania Medicaid cases. Remove prior auth requirements for low-dose antipsychotics. Update system to distinguish between brand/generic equivalency when determining prior auth needs for non-preferred antipsychotics. Review therapeutic duplication rules for atypical vs. typical antipsychotics. Ensure pediatric antipsychotic prescriptions (under 18) continue to require prior auth with appropriate specialist involvement and comprehensive documentation.