MedicaidPrior AuthMedium impact
MAB2019120501
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Family Medicine, Internal Medicine +1 more·Provider Bulletin
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for antidepressants effective January 1, 2020. New guidelines include stricter medical necessity criteria, specific requirements for Spravato (esketamine), and updated renewal procedures for non-preferred antidepressants.
Action Required
By January 1, 2020: Providers prescribing antidepressants for Pennsylvania Medicaid patients must ensure prior authorization requests include: FDA-approved diagnosis indication, age-appropriate dosing, contraindication history, and for non-preferred drugs, documentation of failure/intolerance to at least two preferred options for ≥6 weeks. For Spravato (esketamine), require psychiatrist consultation, treatment-resistant depression diagnosis, and concurrent oral antidepressant therapy. Update prior auth request templates to include these documentation requirements.