MedicaidPrior AuthMedium impact
MAB2019120606
Pennsylvania Medicaid (DHS)·PA · Neurology, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for antimigraine agents, including new guidelines for CGRP antagonists/inhibitors used for migraine prevention and episodic cluster headache treatment. The policy removes the restriction on using botulinum toxin with CGRP medications and adds new specialist prescribing requirements.
Action Required
By January 1, 2020: Update prior authorization procedures for antimigraine agents in Pennsylvania Medicaid cases. Ensure neurologists and certified headache specialists document baseline migraine frequency, therapeutic failures with at least one medication from two of three drug classes (beta-blockers, antidepressants, anticonvulsants), and that patients average 4+ migraine days per month. Remove billing restrictions between botulinum toxin and CGRP medications. Verify only one CGRP antagonist/inhibitor is prescribed per patient.