MedicaidPrior AuthMedium impact
BT202436: Pharmacy updates approved by Drug Utilization Review Board March 2024
Indiana Medicaid (IHCP)·IN · Allergy & Immunology, Pulmonology, OB-GYN +1 more·Prior Authorization
Effective date
May 1, 2024
We identified it
Jun 19, 2026
Summary
Indiana Health Coverage Programs updated prior authorization criteria for Respiratory and Allergy Biologics, established new PA criteria for Non-SUPDL and Step Therapy, and added Opill (norgestrel) as a covered over-the-counter contraceptive product to the formulary.
Action Required
By May 1, 2024: Billing team must review updated prior authorization criteria for Respiratory and Allergy Biologics on the Optum Rx Indiana Medicaid website. Update workflows to include new PA requirements for Non-SUPDL and Step Therapy for fee-for-service claims. For OTC contraception, ensure Opill (norgestrel) is recognized as covered for FFS claims with dates of service on or after May 1, 2024, and managed care claims with dates of service on or after May 15, 2024. Contact Optum Rx Clinical and Technical Help Desk at 855-577-6317 for FFS PA questions.