MedicaidPrior AuthMedium impact
BT202246: Pharmacy updates approved by Drug Utilization Review Board June 2022
Indiana Medicaid (IHCP)·IN · Neurology, Pulmonology, Pain Management·Prior Authorization
Effective date
Aug 1, 2022
We identified it
Jun 19, 2026
Summary
Indiana Medicaid is updating its automated prior authorization system for antimigraine agents, monoclonal antibodies for respiratory conditions, and spinal muscular atrophy agents. Buprenorphine products will no longer be counted in opioid utilization calculations but quantity limits still apply.
Action Required
By August 1, 2022: Billing team must review updated prior authorization criteria on OptumRx Indiana Medicaid website for antimigraine agents, monoclonal antibodies for respiratory conditions, and spinal muscular atrophy agents. Update pharmacy benefit billing procedures to reflect that buprenorphine products are excluded from morphine milligram equivalent calculations but quantity limits still apply. Contact OptumRx Clinical Help Desk at 855-577-6317 for fee-for-service PA requests.