MedicaidPrior AuthMedium impact
MAB2025110604
Pennsylvania Medicaid (DHS)·PA · Psychiatry, Pediatrics, Pharmacy·Provider Bulletin
Effective date
Jan 5, 2026
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) is updating prior authorization requirements for antipsychotic medications, effective January 5, 2026. New requirements include specific guidelines for Opipza (aripiprazole) film, enhanced age-appropriate prescribing criteria for children under 18, and clarified metabolic monitoring requirements for antipsychotics with metabolic risk.
Action Required
Before January 5, 2026: Pharmacy and prescribing staff must update prior authorization procedures for antipsychotic medications in Pennsylvania Medicaid. Review new guidelines requiring contraindication/intolerance documentation for Opipza (aripiprazole) film versus aripiprazole ODT. For pediatric prescriptions under age 18, ensure age-appropriate prescribing documentation per FDA labeling and implement enhanced specialist consultation requirements (pediatric neurologist, child/adolescent psychiatrist, or child development pediatrician). Update prior auth forms to include metabolic monitoring documentation for applicable antipsychotics. Failure to follow new guidelines will result in prior authorization denials.