MedicaidPrior AuthMedium impact
BT2025167: Pharmacy updates approved by Drug Utilization Review Board November 2025
Indiana Medicaid (IHCP)·IN · Psychiatry, Neurology, Family Medicine +2 more·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
Indiana Medicaid has updated prior authorization requirements and drug formulary statuses for multiple medication classes including antipsychotics, antiseizure agents, opioid treatments, and mental health medications. Many previously preferred drugs are now nonpreferred and require step therapy or medical justification for coverage.
Action Required
Before January 1, 2026: Billing and clinical teams must update prior authorization workflows for Indiana Medicaid patients. Review the updated PA criteria on the Optum Rx Indiana Medicaid website for antipsychotics, antiseizure agents, opioid treatments, mental health medications, and other affected drug classes. Update EMR templates to include required step therapy documentation and medical justification requirements. Train providers on new documentation requirements for nonpreferred medications to avoid claim denials.