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BT2026127: Pharmacy updates approved by Drug Utilization Review Board July 2026

Indiana Medicaid (IHCP)·IN · Pharmacy, Pulmonology, Cardiology +6 more·Provider Bulletin
Effective date
Oct 1, 2026
We identified it
Jul 31, 2026
Days to comply
62 days

Summary

Indiana Health Coverage Programs (IHCP) has updated pharmacy prior authorization (PA) criteria, the Statewide Uniform Preferred Drug List (SUPDL), and the Preferred Brand Drug List effective October 1, 2026. Changes include removal of certain brand drugs from SUPDL, updates to step therapy requirements, quantity limit modifications, and preferred status changes for multiple drug classes including respiratory agents, cardiac medications, mental health drugs, and immunomodulators. PA system enhancements affect 9 drug categories with new automated criteria.

Action Required

Before Oct 1, 2026
By September 15, 2026: Billing and clinical teams must update pharmacy benefit management (PBM) system, EHR prior authorization templates, and formulary lookup tools to reflect all SUPDL and Preferred Brand Drug List changes effective October 1, 2026. Specifically: (1) Remove from SUPDL coverage: Airduo Respiclick, Sitavig, Brexafemme, Vfend brand, Accuretic brand, Lotrel brand, Micardis brand, Verelan brand, Onzetra Xsail; (2) Update step therapy requirements for Airsupra, Breztri, Sdamlo, Widaplik, Bysanti, atomoxetine oral solutions, Arynta, and Humalog KwikPen 200 units/mL per table specifications; (3) Remove quantity limits for Breyna, budesonide/formoterol generics, tiotropium capsules, umeclidinium/vilanterol, eletriptan generic, and mirabegron granules; (4) Change preferred status for multiple drugs (Ebglyss, Starjemza, Tremfya preferred; Praluent, Selarsdi, tofacitinib formulations, sitagliptin products nonpreferred); (5) Add quantity limit (2 inhalers/30 days) to beclomethasone HFA; (6) Update Preferred Brand Drug List by adding Cotempla XR-ODT, Janumet, Januvia, Myrbetriq granules, Xeljanz IR/solution and removing Emtriva, Rectiv; (7) Update PA criteria for Antimigraine Agents, Antipsychotics, Clonidine-Guanfacine, Multiple Sclerosis Agents, Opioid Overutilization, Respiratory Biologics, Stimulants, SSRIs/SNRIs Duplicate Therapy, and Targeted Immunomodulators; (8) Establish new PA criteria for Gaucher Disease agents, Nephrotic Cystinosis agents, Cardamyst, Cardiac Agents, IgAN Agents, Non-SUPDL Agents, PCSK9 Inhibitors, Spinal Muscular Atrophy Agents, Tzield, and Vaginal Infection Antimicrobials. Providers and pharmacy staff must verify prior authorization requirements before dispensing. Failure to implement changes will result in claim denials for prescriptions claiming October 1, 2026 or later dates of service. Reference Optum Rx Indiana Medicaid website for complete PA criteria details; contact 855-577-6317 for questions.