MedicaidPrior AuthMedium impact
BT2023108: Pharmacy updates approved by Drug Utilization Review Board August 2023
Indiana Medicaid (IHCP)·IN · Psychiatry, Neurology, Pulmonology +4 more·Prior Authorization
Effective date
Oct 1, 2023
We identified it
Jun 19, 2026
Summary
Indiana Medicaid updated prior authorization criteria for multiple drug categories and modified the Statewide Uniform Preferred Drug List (SUPDL) with new step therapy requirements and preferred/non-preferred status changes for various medications. The changes include enhanced automated prior authorization criteria for antipsychotics, respiratory biologics, and other specialty drugs, plus new utilization edits for mental health medications.
Action Required
By October 1, 2023: Billing team must update prior authorization workflows for affected drug categories including Antimigraine Agents, Antipsychotic Agents, Multiple Sclerosis Agents, Respiratory and Allergy Biologics, and others. Review the updated PA criteria on the Optum Rx Indiana Medicaid website and ensure staff are aware of new step therapy requirements for preferred drug list changes. Claims may be denied if new PA requirements are not met.