MedicaidPrior AuthMedium impact
Prior Authorization of Acne Agents, Oral – Pharmacy Services MAB 01-19-34
Pennsylvania Medicaid (DHS)·PA · Dermatology, Family Medicine, Pediatrics·Prior Authorization
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) now requires prior authorization for all oral acne medications effective January 1, 2020. Prescriptions must meet specific criteria including prescription by or consultation with a dermatologist and documented failure of topical treatments.
Action Required
By January 1, 2020: Billing and clinical staff must obtain prior authorization for all oral acne medications for Pennsylvania Medicaid patients. Providers must document dermatologist consultation/prescription and therapeutic failure of oral antibiotics, topical antibiotics, and topical tretinoin. Update prior authorization workflows to include these requirements. Claims will be denied without proper prior authorization.