MedicaidPrior AuthMedium impact
MAB2021110805
Pennsylvania Medicaid (DHS)·PA · Gastroenterology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for ALL GI Motility, Chronic Agent prescriptions effective January 3, 2022. New guidelines require documented failure of basic treatments (laxatives, fiber, etc.) for constipation drugs and gastroenterologist consultation for diarrhea medications.
Action Required
By January 3, 2022: Billing and clinical teams must obtain prior authorization for ALL GI Motility, Chronic Agent prescriptions for Pennsylvania Medicaid patients. Providers must document therapeutic failure of basic treatments (laxatives, fiber supplements, osmotic agents) for constipation medications. For diarrhea treatments, require gastroenterologist consultation and documented FODMAP diet failure. Update EMR templates to capture required documentation. Claims will be denied without proper prior authorization.