MedicaidPrior AuthMedium impact
MAB2020110903
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for non-preferred antidepressants, allowing patients with a 90-day prescription history to bypass clinical guidelines. The policy also removed specific treatment-resistant depression requirements for Spravato (esketamine) since FDA expanded its approved indications.
Action Required
By January 5, 2021: Billing and clinical staff must update prior authorization processes for Pennsylvania Medicaid patients prescribed non-preferred antidepressants. Document any 90-day prescription history to bypass clinical guidelines. For Spravato prescriptions, ensure psychiatrist involvement and oral antidepressant combination are documented. Update EMR templates to capture required documentation elements.