MedicaidPrior AuthMedium impact
BT202008: Pharmacy update approved by Drug Utilization Review Board January 2020
Indiana Medicaid (IHCP)·IN · Endocrinology, Oncology, OB-GYN +1 more·Prior Authorization
Effective date
Mar 1, 2020
We identified it
Jun 19, 2026
Summary
Indiana Medicaid has updated prior authorization criteria for Targeted Immunomodulators and removed PA criteria for GnRH Analogs, except for triptorelin pamoate which now requires patients to be 12 years or older. These changes affect the automated SilentAuth PA system for fee-for-service pharmacy benefits.
Action Required
By March 1, 2020: Billing and pharmacy teams must review updated prior authorization criteria for Targeted Immunomodulators on the OptumRx Indiana Medicaid website. Update patient eligibility verification processes to reflect that most GnRH Analogs no longer require PA, except triptorelin pamoate which requires patients to be 12+ years old. Contact OptumRx Clinical Help Desk at 1-855-577-6317 for FFS PA requests.