MedicaidPrior AuthMedium impact
MAB2020111304
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Neurology, Pediatrics +4 more·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for sedative hypnotic benzodiazepines when prescribed to patients under 21, when there's therapeutic duplication with other benzodiazepines, or when multiple benzodiazepine prescriptions occur within 30 days. Additional medical necessity documentation requirements have been added for non-preferred sedative hypnotics.
Action Required
By January 5, 2021: Billing and clinical teams must update prior authorization workflows for sedative hypnotic benzodiazepines prescribed to Pennsylvania Medicaid patients under 21 or when therapeutic duplication occurs. Train providers on new medical necessity documentation requirements including diagnosis verification, therapeutic failure history, and FDA-approved indication compliance. Update EMR alerts to flag potential prior authorization needs based on patient age and concurrent benzodiazepine use.