MedicaidPrior AuthMedium impact
MAB2020111203
Pennsylvania Medicaid (DHS)·PA · Neurology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing new prior authorization requirements for migraine medications including new drug classes (gepants, ditans, ergot alkaloids) and updated medical necessity criteria. All migraine acute treatment agents will require stricter documentation and stepped therapy protocols.
Action Required
By January 5, 2021: Billing and clinical teams must update prior authorization workflows for migraine medications in Pennsylvania Medicaid patients. Providers must document therapeutic failure of preferred triptans before prescribing gepants, ditans, or ergot alkaloids. Update EMR templates to include International Headache Society diagnostic criteria and contraindication history. Ensure age-appropriate prescribing documentation per FDA labeling. Claims for non-preferred agents without proper prior authorization will be denied.