MedicaidPrior AuthMedium impact
MAB - Requirements for Prior Authorization of Antipsychotics
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Pharmacy·Prior Authorization
Effective date
Jan 20, 2016
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) updated prior authorization requirements for antipsychotic medications, adding four new drugs to low-dose prior auth requirements: Rexulti, Saphris, Symbyax, and Versacloz. The policy maintains a 60-day exemption for initial therapy titration but requires prior auth for continued low-dose use.
Action Required
By January 20, 2016: Pharmacy and billing teams must update prior authorization processes to include Rexulti (≤0.5mg), Saphris (≤5mg), Symbyax (≤3/25mg), and Versacloz (≤50mg) in low-dose antipsychotic prior auth requirements for PA Medicaid patients 18+ years. Update billing systems to flag these medications for prior auth after the initial 60-day exemption period. Prescribers must follow Section I procedures for prior authorization requests.