MedicaidPrior AuthMedium impact
MAB2021111703
Pennsylvania Medicaid (DHS)·PA · Family Medicine, Internal Medicine, General Practice +5 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is removing the prior authorization requirement for skeletal muscle relaxants that represent therapeutic duplication, effective January 3, 2022. Prior authorization will still be required for non-preferred drugs, quantity limit overages, and controlled substances with concurrent buprenorphine therapy.
Action Required
By January 3, 2022: Update prior authorization workflows to remove PA requirements for therapeutic duplication of skeletal muscle relaxants for Pennsylvania Medicaid patients. Continue requiring PA for non-preferred skeletal muscle relaxants, quantity overages, and controlled substances with concurrent buprenorphine therapy. Train staff on updated medical necessity guidelines and ensure documentation includes PDMP searches for controlled substances.