MedicaidPrior AuthMedium impact
MAB2020111204
Pennsylvania Medicaid (DHS)·PA · Neurology, Family Medicine, Internal Medicine·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for migraine prevention medications, changing the class name from 'Antimigraine Agents, Other' to 'Migraine Prevention Agents' and adding new restrictions prohibiting concurrent use with other migraine prevention agents or CGRP receptor antagonists. All prescriptions in this class require prior authorization with specific documentation requirements including specialist prescriber certification and failure of first-line treatments.
Action Required
By January 5, 2021: Update billing system terminology from 'Antimigraine Agents, Other' to 'Migraine Prevention Agents' for Pennsylvania Medicaid prior authorization tracking. Ensure prior authorization requests for migraine prevention medications include documentation that patient will not be using concurrent migraine prevention agents or CGRP receptor antagonists. Verify prescriber is neurologist or UCNS-certified headache specialist before submitting authorization requests.