MedicaidPrior AuthMedium impact
BT202175: Pharmacy update approved by Drug Utilization Review Board August 2021
Indiana Medicaid (IHCP)·IN · Psychiatry, Cardiology, Neurology +2 more·Prior Authorization
Effective date
Oct 1, 2021
We identified it
Jun 19, 2026
Summary
Indiana Health Coverage Programs updated prior authorization criteria for multiple drug categories and modified the Preferred Drug List status for various medications. Changes include new PA requirements for cardiac agents, PCSK9 inhibitors, antimigraine agents, and updated utilization edits for mental health medications.
Action Required
By October 1, 2021: Billing and pharmacy teams must review the updated PA criteria on the OptumRx Indiana Medicaid website for affected drug categories including Antipsychotic Therapy, Duplicate SSRI/SNRI, Monoclonal Antibodies, Multiple Sclerosis Agents, Cardiac Agents, PCSK9 Inhibitors, and Antimigraine Agents. Update prior authorization workflows to reflect new PDL preferred/nonpreferred status changes and new utilization limits for mental health medications. Contact OptumRx Clinical Help Desk at 855-577-6317 for FFS PA requests.