MedicaidPrior AuthMedium impact
Expansion of the PeerReview Pre-Authorization Program of Antipsychotic Medications for Youth Less Than 10 Years Old
Maryland Medicaid·MD · Pediatrics, Psychiatry, Family Medicine +1 more·Pharmacy
We identified it
Jun 20, 2026
Summary
Maryland Medicaid is expanding the peer review pre-authorization program to require prior authorization for all antipsychotic medications prescribed to children under 10 years old. This adds a new layer of review beyond standard prior authorization to ensure appropriate prescribing for this vulnerable population.
Action Required
Immediately: Billing and clinical staff must implement peer review pre-authorization process for all antipsychotic medications prescribed to patients under 10 years old covered by Maryland Medicaid. Providers must obtain both standard prior authorization AND peer review approval before prescribing. Update EMR alerts and workflows to flag these cases. Claims for antipsychotic medications in this age group will be denied without proper peer review authorization.