MedicaidPrior AuthMedium impact
MAB2020110601
Pennsylvania Medicaid (DHS)·PA · Pain Management, Palliative Care, Oncology +2 more·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for long-acting opioid analgesics, effective January 5, 2021. The changes include clarified guidelines for non-opioid pain management alternatives, revised PDMP requirements for certain diagnoses, new therapeutic duplication guidelines, and extended approval periods up to 6 months.
Action Required
By January 5, 2021: Providers prescribing long-acting opioids for Pennsylvania Medicaid patients must update documentation requirements to include examples of non-opioid analgesics (gabapentinoids, duloxetine, tricyclic antidepressants) in prior authorization requests. Billing team should verify all long-acting opioid prescriptions have proper prior authorization before dispensing. Claims without prior authorization will be denied.