MedicaidPrior AuthMedium impact
MAB2021110401
Pennsylvania Medicaid (DHS)·PA · Dermatology, Family Medicine, General Practice +1 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing new prior authorization requirements for non-preferred topical antiparasitic medications, with specific restrictions on lindane including weight requirements and contraindications for seizure-lowering medications.
Action Required
By January 3, 2022: Billing team must update prior authorization protocols for topical antiparasitic medications. Verify patients weigh ≥50 pounds and document absence of seizure-threshold-lowering medications before prescribing lindane. For all other non-preferred topical antiparasitics, document therapeutic failure, contraindication, or intolerance to preferred medications. Update EMR templates to capture required clinical criteria. Claims without proper prior authorization will be denied.