MedicaidPrior AuthMedium impact
MAB2021111204
Pennsylvania Medicaid (DHS)·PA · Family Medicine, Internal Medicine, Psychiatry +2 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization guidelines for opioid dependence treatments, adding new requirements for Lucemyra (lofexidine) that doses and duration must be consistent with FDA labeling or peer-reviewed literature. The policy also reinforces existing prior authorization requirements for buprenorphine treatments, non-preferred drugs, and quantity limit exceptions.
Action Required
By January 3, 2022: Billing team must ensure prior authorization is obtained for all Pennsylvania Medicaid prescriptions for: (1) oral buprenorphine without naloxone, (2) non-preferred opioid dependence treatments, (3) quantities exceeding limits, and (4) Lucemyra with documentation of appropriate dosing. Update prior authorization request templates to include required documentation elements including Pennsylvania PDMP search results and medical necessity justification.