MedicaidPrior AuthHigh impact
BT2020121: Pharmacy updates approved by Drug Utilization Review Board November 2020
Indiana Medicaid (IHCP)·IN · Psychiatry, Neurology, Endocrinology +8 more·Prior Authorization
Effective date
Jan 1, 2021
We identified it
Jun 19, 2026
Summary
Indiana Medicaid updated prior authorization criteria, preferred drug list status, and formulary coverage for multiple drug classes effective January 1, 2021. Key changes include enhanced automated PA systems for antiseizure agents, antipsychotics, and targeted immunomodulators, plus numerous drugs switching between preferred and non-preferred status.
Action Required
By January 1, 2021: Billing and clinical teams must update prior authorization workflows for antiseizure agents, antipsychotics (April 1, 2021), SSRI/SNRI duplicate therapy, targeted immunomodulators, opiate overutilization, and monoclonal antibodies. Update formulary lists in prescribing systems to reflect preferred/non-preferred status changes for dozens of medications across multiple drug classes. Verify new PA criteria on OptumRx Indiana Medicaid website before submitting requests. Claims may be denied if new PA requirements are not followed.