MedicaidPrior AuthLow impact
Prior Authorization of Xyrem (sodium oxybate) – Pharmacy Services MAB 01-19-18
Pennsylvania Medicaid (DHS)·PA · Sleep Medicine, Neurology, Pharmacy·Prior Authorization
Effective date
Jul 8, 2019
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid updated prior authorization requirements for Xyrem (sodium oxybate), expanding coverage to children 7+ years old and removing redundant REMS enrollment requirements. All prescriptions for Xyrem still require prior authorization with extensive clinical criteria including sleep studies, drug screening, and failure of other treatments.
Action Required
By July 8, 2019: Pennsylvania Medicaid providers must update prior authorization requests for Xyrem to include new age criteria (7+ years) and remove REMS enrollment documentation. Ensure all clinical requirements including sleep studies, drug screens, alcohol abstinence documentation, and treatment failure records are included in authorization requests.