MedicaidPrior AuthMedium impact
BT202294: Pharmacy updates approved by Drug Utilization Review Board October 2022
Indiana Medicaid (IHCP)·IN · Pulmonology, Allergy & Immunology, Family Medicine +2 more·Prior Authorization
Effective date
Dec 1, 2022
We identified it
Jun 19, 2026
Summary
Indiana Medicaid has updated prior authorization criteria for Respiratory and Allergy Biologics and Cystic Fibrosis Agents, changed three short-acting beta agonist inhalers to preferred status on the PDL, and updated age restrictions for Vaxneuvance vaccine. These changes affect the fee-for-service pharmacy benefit only.
Action Required
By December 1, 2022: Pharmacy and billing teams must update prior authorization workflows for Respiratory and Allergy Biologics and Cystic Fibrosis Agents by reviewing new criteria on OptumRx Indiana Medicaid website. Update formulary systems to reflect Proventil HFA, Ventolin HFA, and Albuterol HFA as preferred drugs. Update vaccine billing system to restrict Vaxneuvance to patients 19 years and older. Contact OptumRx Clinical and Technical Help Desk at 855-577-6317 for PA requests.