MedicaidPrior AuthMedium impact
MAB2021110501
Pennsylvania Medicaid (DHS)·PA · Urology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is implementing new prior authorization requirements for bladder relaxant preparations effective January 3, 2022. Non-preferred bladder relaxants, quantities exceeding limits, and therapeutic duplications will require prior authorization with specific medical necessity criteria.
Action Required
Before January 3, 2022: Update billing system to flag non-preferred bladder relaxant preparations for prior authorization requirements. Train staff to verify preferred drug list status at https://papdl.com/preferred-drug-list before prescribing. Ensure providers document therapeutic failure, contraindication, or intolerance for non-preferred drugs. Update clinical workflows to check for therapeutic duplication of urinary antispasmodics and beta-3 agonists. Claims without proper prior authorization will be denied.