MedicaidPrior AuthMedium impact
BT202140: Pharmacy updates approved by Drug Utilization Review Board May 2021
Indiana Medicaid (IHCP)·IN · Psychiatry, Endocrinology, Urology +4 more·Prior Authorization
Effective date
Jul 1, 2021
We identified it
Jun 19, 2026
Summary
Indiana Medicaid has updated prior authorization criteria for multiple drug classes, added new mental health medication quantity limits, and modified the Preferred Drug List with changes to coverage status for various medications including testosterone products, narcotics, and ophthalmic agents.
Action Required
By July 1, 2021: Billing and clinical staff must update prior authorization workflows for Growth Hormone, Ophthalmic Anti-Inflammatory/Immunomodulator-Type, Allergy-Specific Immunotherapy, and Spinal Muscular Atrophy Agents. Review updated SilentAuth criteria for Duplicate Stimulants, Sedative-Hypnotic/Benzodiazepines, Antiseizure Agents, Opiate Overutilization and Targeted Immunomodulators. Update pharmacy benefit verification processes to reflect new PDL status changes and quantity limits for mental health medications. Access updated criteria at OptumRx Indiana Medicaid website via in.gov/medicaid/providers.