MedicaidPrior AuthMedium impact
MAB2021111601
Pennsylvania Medicaid (DHS)·PA · Neurology, Psychiatry, Pharmacy·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has updated prior authorization requirements for VMAT2 inhibitors (medications for tardive dyskinesia and chorea). Key changes include requiring prescriptions by neurologists or psychiatrists, removing certain dosing restrictions, and adding specific renewal criteria for continued treatment.
Action Required
By January 3, 2022: Update prior authorization procedures for VMAT2 inhibitors for Pennsylvania Medicaid patients. Ensure prescriptions are written by or in consultation with neurologists or psychiatrists. Update documentation requirements to include mental health evaluations, validated scales for tardive dyskinesia severity, and clinical benefit assessments for renewals. Train staff on new guidelines that no longer require CYP2D6 metabolizer status documentation.