MedicaidPrior AuthMedium impact
BT2023125: Pharmacy updates approved by Drug Utilization Review Board September 2023
Indiana Medicaid (IHCP)·IN · Cardiology, Infectious Disease·Prior Authorization
Effective date
Oct 1, 2023
We identified it
Jun 19, 2026
Summary
The Indiana Health Coverage Programs (IHCP) has established new prior authorization requirements for Antiviral Monoclonal Antibodies, Daybue, Miscellaneous Cardiac Agents, and Vyjuvek, effective November 1, 2023. Additionally, the Preferred Brand Drug List has been updated with changes effective October 1, 2023.
Action Required
By October 31, 2023: Billing team must review updated Preferred Brand Drug List on Optum Rx Indiana Medicaid website and update billing software to require prior authorization for Antiviral Monoclonal Antibodies, Daybue, Miscellaneous Cardiac Agents, and Vyjuvek starting November 1, 2023. Contact Optum Rx Clinical and Technical Help Desk at 855-577-6317 for FFS PA requests. Claims without proper prior authorization will be subject to denial.