MedicaidPrior AuthHigh impact
MAB2025110605
Pennsylvania Medicaid (DHS)·PA · Pain Management, Emergency Medicine, Orthopedics +3 more·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance is adding analgesics and acute pain agents (including new drug Journavx) to the Preferred Drug List requiring prior authorization for all prescriptions. Providers must demonstrate failure or contraindication to acetaminophen and NSAIDs before approval.
Action Required
By January 5, 2026: Update billing system to flag all analgesic/acute pain agent prescriptions for prior authorization requirement. Train staff on new PA requirements including documentation of acetaminophen and NSAID failures. Update encounter forms to remind providers of PA necessity. Claims without prior authorization will be denied.