MedicaidPrior AuthMedium impact
MAB2025110602
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Family Medicine, Internal Medicine +1 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 antidepressant medications effective January 5, 2026. The key change removes the requirement that Spravato (esketamine) must be prescribed in conjunction with oral antidepressants, allowing it to be used as standalone therapy when other criteria are met.
Action Required
By January 5, 2026: Billing and clinical teams must update prior authorization procedures for antidepressant medications under Pennsylvania Medicaid. Remove the requirement for concurrent oral antidepressant therapy when requesting prior auth for Spravato (esketamine). Update clinical documentation templates to reflect new Spravato criteria focusing on prescriber qualifications (psychiatrist consultation required) and hepatic impairment screening. Ensure staff understand that Zurzuvae, other non-preferred antidepressants, and quantity limit exceptions still require comprehensive prior authorization with specific clinical criteria.