MedicaidPrior AuthMedium impact
MAB2025111202
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Neurology, Pediatrics +2 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization requirements for stimulants and related agents, adding a new requirement that prescriptions must be for FDA-approved indications or medically accepted uses. The change affects all pharmacies and prescribers treating Medicaid beneficiaries in both fee-for-service and managed care systems.
Action Required
Before January 5, 2026: Providers prescribing stimulants to Pennsylvania Medicaid patients must ensure all prescriptions are for FDA-approved indications or medically accepted uses. Update prior authorization request procedures to include documentation of appropriate indication. Billing team should verify updated handbook requirements are followed for all stimulant prior authorization requests to prevent claim denials.