MedicaidPrior AuthMedium impact
BT202241: Pharmacy updates approved by Drug Utilization Review Board May 2022
Indiana Medicaid (IHCP)·IN · Endocrinology, Neurology, Psychiatry +3 more·Prior Authorization
Effective date
Jul 1, 2022
We identified it
Jun 19, 2026
Summary
Indiana Medicaid updated prior authorization criteria for multiple drug classes and changed Preferred Drug List (PDL) status for numerous medications, including antiseizure agents, diabetes medications, growth hormones, and other specialty drugs. These changes affect pharmacy benefit coverage and require updated PA processes for fee-for-service Medicaid patients.
Action Required
By July 1, 2022: Billing team must verify updated prior authorization requirements for Indiana Medicaid patients receiving medications in affected drug classes including antiseizure agents, diabetes medications, growth hormones, and specialty drugs. Update prior authorization workflow to check new PDL status and PA criteria on OptumRx Indiana Medicaid website before prescribing. Train providers on new utilization edits and quantity limits for mental health medications.