MedicaidPrior AuthMedium impact
BT202372: Pharmacy updates approved by Drug Utilization Review Board June 2023
Indiana Medicaid (IHCP)·IN · Neurology, Endocrinology, Family Medicine +2 more·Prior Authorization
Effective date
Aug 1, 2023
We identified it
Jun 19, 2026
Summary
Indiana Medicaid (IHCP) has established new prior authorization criteria for Alzheimer's drugs Aduhelm and Leqembi, and updated step therapy requirements for metformin HCl solution (Riomet) while removing it from the Preferred Drug List. These changes affect fee-for-service pharmacy benefits only.
Action Required
Before August 1, 2023: Billing and clinical staff must obtain prior authorization for Aduhelm and Leqembi prescriptions through Optum Rx (855-577-6317). Update protocols to ensure metformin HCl solution (Riomet) is only prescribed for patients under 18 or unable to swallow tablets, as it's no longer on PDL. Verify PA criteria on Optum Rx Indiana Medicaid website before prescribing.