MedicaidPrior AuthMedium impact
BT2024120: Pharmacy updates approved by Drug Utilization Review Board July 2024
Indiana Medicaid (IHCP)·IN · Neurology, Dermatology, Endocrinology +1 more·Prior Authorization
Effective date
Sep 1, 2024
We identified it
Jun 19, 2026
Summary
Indiana Medicaid has established new prior authorization requirements for four drug categories: Complement Inhibitor Agents, Elevidys, Epidermolysis Bullosa Agents, and Muscular Dystrophy Agents. These changes only apply to fee-for-service Medicaid and take effect September 1, 2024.
Action Required
Before September 1, 2024: Billing team must review new prior authorization criteria on the Optum Rx Indiana Medicaid website for Complement Inhibitor Agents, Elevidys, Epidermolysis Bullosa Agents, and Muscular Dystrophy Agents. Update billing workflows to require prior authorization for these drug categories for Indiana Medicaid fee-for-service patients only. Contact Optum Rx Clinical and Technical Help Desk at 855-577-6317 for prior authorization requests.