MedicaidPrior AuthMedium impact
Prior Authorization of Penicillins – Pharmacy Services MAB 01-19-23
Pennsylvania Medicaid (DHS)·PA·Prior Authorization
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid now requires prior authorization for all non-preferred penicillin antibiotics effective January 1, 2020. Pharmacies and prescribers must obtain prior auth unless the patient has documented therapeutic failure, intolerance, contraindication to preferred penicillins, or culture results showing only non-preferred penicillins will be effective.
Action Required
Immediately: Prescribers must check the Pennsylvania Preferred Drug List (PDL) at https://papdl.com/preferred-drug-list before prescribing penicillins for Medicaid patients. When prescribing non-preferred penicillins, document therapeutic failure/intolerance of preferred options or obtain culture and sensitivity results. Billing team must ensure prior authorization is obtained for all non-preferred penicillin prescriptions or claims will be denied.