MedicaidPrior AuthMedium impact
MAB2020121401
Pennsylvania Medicaid (DHS)·PA · Neurology, Sleep Medicine, Family Medicine +1 more·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for Xywav (calcium, magnesium, potassium, and sodium oxybates) prescriptions, combining it with existing Xyrem prior auth requirements. This affects pharmacies and prescribers in Pennsylvania's fee-for-service Medicaid program starting January 5, 2021.
Action Required
By January 5, 2021: Prescribers must obtain prior authorization for all Xywav and Xyrem prescriptions for Pennsylvania Medicaid fee-for-service patients. Ensure documentation includes urine drug screening, PDMP search, therapeutic failure history with other medications, and appropriate diagnosis codes. Pharmacies must verify prior authorization before dispensing. Managed care patients should contact their specific MCO for requirements.