MedicaidPrior AuthMedium impact
MAB - Requirements for Prior Authorization of Stimulants and Related Agents
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Pediatrics, Neurology +2 more·Prior Authorization
Effective date
Jan 20, 2016
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) updated prior authorization requirements for stimulants and related agents, adding new criteria for Vyvanse when prescribed for binge eating disorder and establishing specific requirements for different age groups and therapeutic situations.
Action Required
By January 20, 2016: Billing team must update prior authorization procedures for stimulant medications under Pennsylvania Medicaid. Ensure prior auth is obtained for: non-preferred stimulants, preferred stimulants exceeding quantity limits, any stimulants for patients under 4 or 18+ years old (except Provigil/Nuvigil for adults), and therapeutic duplications. Update encounter forms to remind providers of new Vyvanse approval for binge eating disorder and required specialist consultations for pediatric cases under 4 years.