MedicaidPrior AuthMedium impact
MAB2019120505
Pennsylvania Medicaid (DHS)·PA · Family Medicine, Internal Medicine, Psychiatry +2 more·Provider Bulletin
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for opioid dependence treatments, including new guidelines for buprenorphine prescriptions, CNS depressant combinations, and added coverage for newly FDA-approved Lucemyra (lofexidine). The policy clarifies which opioid addiction medications require prior auth and strengthens documentation requirements.
Action Required
By January 1, 2020: Billing team must update prior authorization protocols for Pennsylvania Medicaid opioid dependence treatment prescriptions. Ensure pharmacy staff verify prior auth requirements for: oral buprenorphine without naloxone, buprenorphine combined with benzodiazepines/CNS depressants, non-oral buprenorphine, non-preferred treatments, and quantities exceeding limits. Update documentation requirements to include prescription drug monitoring program searches and drug screening results. Claims without proper prior authorization will be denied.