MedicaidPrior AuthHigh impact
BT2025154: IHCP updates PA requirements for certain physician-administered drugs
Indiana Medicaid (IHCP)·IN · Rheumatology, Allergy & Immunology, Pulmonology +2 more·Provider Bulletin
Effective date
Dec 1, 2025
We identified it
Jun 18, 2026
Summary
Indiana Medicaid (IHCP) is implementing new prior authorization requirements for three physician-administered drugs effective December 1, 2025. Golimumab (J1602) and tocilizumab (J3262) will now require prior auth under the medical benefit, while omalizumab (J2357) criteria are being revised to align with pharmacy benefit requirements.
Action Required
By December 1, 2025: Billing team must update system to require prior authorization for HCPCS codes J1602 (golimumab), J2357 (omalizumab), and J3262 (tocilizumab) for Indiana Medicaid fee-for-service patients. Submit PA requests through Acentra Health at 866-725-9991. Update encounter forms to alert providers. Claims without proper prior authorization will be denied.