MedicaidPrior AuthHigh impact
MAB2019120603
Pennsylvania Medicaid (DHS)·PA · Pain Management, Oncology, Palliative Care +4 more·Provider Bulletin
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is implementing new prior authorization requirements for opioid short-acting analgesics effective January 1, 2020. Key changes include revised guidelines for transmucosal fentanyl and nasal butorphanol prescribing, expanded specialty prescriber lists, and clarification that quantity limit renewals require prior authorization.
Action Required
By January 1, 2020: Update prior authorization workflows for opioid short-acting analgesics in Pennsylvania Medicaid claims. Train providers on new specialty prescriber requirements for transmucosal fentanyl (now includes hospice/palliative care specialists) and nasal butorphanol (expanded to include oncology and hospice/palliative care specialists). Update billing system to flag quantity limit renewals as requiring prior authorization. Notify prescribers that automated approvals no longer apply to claims exceeding quantity limits.