MedicaidPrior AuthMedium impact
BT2022110: Pharmacy updates approved by Drug Utilization Review Board November 2022
Indiana Medicaid (IHCP)·IN · Psychiatry, Endocrinology, Neurology +3 more·Prior Authorization
Effective date
Jan 1, 2023
We identified it
Jun 19, 2026
Summary
Indiana Medicaid has updated prior authorization criteria for multiple drug classes, changed preferred drug list status for numerous medications, and modified mental health utilization edits. These changes affect pharmacy benefits and require updated PA requests and billing procedures.
Action Required
By January 1, 2023: Billing team must update prior authorization procedures for affected drug classes including Antiseizure Agents, GLP-1 Receptor Agonists, SGLT2 Inhibitors, Growth Hormones, Dry Eye Disease treatments, and Mental Health medications. Review updated PA criteria on OptumRx Indiana Medicaid website. Update system edits for mental health medication quantity limits and age restrictions. Verify preferred drug list status before submitting pharmacy claims to avoid denials.