MedicaidPrior AuthMedium impact
MAB2021111003
Pennsylvania Medicaid (DHS)·PA · Neurology, Family Medicine, Internal Medicine·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 migraine prevention medications. All prescriptions for migraine prevention agents must now have prior authorization with updated medical necessity guidelines including requirements for specialist prescribing and documented medication failures.
Action Required
By January 3, 2022: Billing team must update prior authorization procedures for all migraine prevention medication prescriptions in Pennsylvania Medicaid. Ensure providers document: 1) Baseline migraine frequency (4+ migraine days per month), 2) Therapeutic failure of at least one medication from two classes (beta-blockers, antidepressants, anticonvulsants), 3) Prescriber is neurologist or certified headache specialist. Update encounter forms and EMR templates to capture required documentation. Claims will be denied without proper prior authorization.