MedicaidPrior AuthMedium impact
MAB2021111002
Pennsylvania Medicaid (DHS)·PA · Neurology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for migraine acute treatment agents, including new guidelines for gepants, ditans, and ergot alkaloids. The changes clarify when prior auth is needed for different migraine medications and specify therapeutic failure requirements for newer drug classes.
Action Required
By January 3, 2022: Billing team must update prior authorization workflows for Pennsylvania Medicaid patients receiving migraine acute treatment agents (gepants, ditans, ergot alkaloids). Ensure documentation includes therapeutic failure history for at least two triptans before prescribing gepants or ditans. Update PA request forms to include required clinical criteria. Claims without proper prior authorization will be denied.