MAB2020110904

Before January 5, 2021: Billing team and prescribers must update prior authorization procedures for anxiolytic benzodiazepines in Pennsylvania Medicaid patients. Key changes: (1) Exclude clobazam and seizure-specific benzodiazepines from therapeutic duplication rules, (2) Obtain prior auth for concurrent benzodiazepine/buprenorphine prescriptions with documentation of prescriber coordination, (3) Ensure PDMP searches are documented for controlled substances unless patient has qualifying conditions (seizures, palliative care, etc.), (4) Update workflow to verify all prescribers are aware when multiple benzodiazepines are prescribed. Failure to obtain required prior authorization will result in claim denials.