MedicaidPrior AuthMedium impact
BT2021105: Pharmacy updates approved by Drug Utilization Review Board November 2021
Indiana Medicaid (IHCP)·IN · Family Medicine, Internal Medicine, General Practice +8 more·Prior Authorization
Effective date
Jan 1, 2022
We identified it
Jun 19, 2026
Summary
Indiana Medicaid updated their Preferred Drug List, prior authorization requirements, and utilization edits for multiple medication classes effective January 1, 2022. Changes include new PA criteria for several drug classes, updated mental health medication quantity limits, and status changes for preferred/non-preferred medications.
Action Required
Before January 1, 2022: Billing and clinical teams must update prior authorization processes for Antipsychotics, Antiseizure Agents, COX II Inhibitors, Sedative-Hypnotics/Benzodiazepines, SGLT2 Inhibitors, Targeted Immunomodulators, Topical Immunomodulators, and Treatments for Xerophthalmia. Review updated Preferred Drug List changes for medication coverage status. Update pharmacy benefit verification processes to reflect new formulary preferences. Access updated PA criteria on OptumRx Indiana Medicaid website. Claims may be denied without proper prior authorization for affected medications.