MedicaidPrior AuthMedium impact
Prior Authorization of Skeletal Muscle Relaxants – Pharmacy Services MAB 01-19-89
Pennsylvania Medicaid (DHS)·PA · Family Medicine, Internal Medicine, General Practice +5 more·Prior Authorization
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for skeletal muscle relaxants in four specific scenarios: non-preferred drugs, quantities exceeding limits, controlled substances prescribed with buprenorphine for opioid treatment, and therapeutic duplications. New documentation requirements include Pennsylvania Prescription Drug Monitoring Program searches for controlled substances.
Action Required
By January 1, 2020: Billing team must update prior authorization workflows for Pennsylvania Medicaid skeletal muscle relaxant prescriptions. Verify preferred drug list status, quantity limits, and concurrent buprenorphine prescriptions before dispensing. Providers must document PDMP searches for controlled skeletal muscle relaxants and maintain records of therapeutic failure/contraindications for non-preferred agents. Claims will be denied without proper prior authorization.