MedicaidPrior AuthMedium impact
MAB2020111301
Pennsylvania Medicaid (DHS)·PA · Family Medicine, Internal Medicine, Psychiatry +2 more·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for opioid dependence treatments, removing some prior auth requirements for oral buprenorphine when used with benzodiazepines and simplifying guidelines for non-oral buprenorphine treatments. The policy also clarifies that other medications (benzodiazepines, opioids, sedatives) require prior authorization when prescribed concurrently with buprenorphine.
Action Required
By January 5, 2021: Update prior authorization workflows to reflect that oral buprenorphine no longer requires prior auth when used with benzodiazepines or CNS depressants. Ensure staff know that benzodiazepines, opioid analgesics, controlled sedatives, and carisoprodol still require prior authorization when prescribed with buprenorphine treatments. Review current opioid dependence treatment claims to ensure compliance with updated medical necessity guidelines.