MedicaidPrior AuthLow impact
BT2025152: Pharmacy updates approved by Drug Utilization Review Board October 2025
Indiana Medicaid (IHCP)·IN · Family Medicine, Internal Medicine, Rheumatology +2 more·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
Indiana Medicaid has updated prior authorization criteria for Targeted Immunomodulators and established new PA requirements for Agents for Thrombocytopenia and Vykat XR, plus made changes to their preferred drug lists. These pharmacy changes affect both fee-for-service and managed care Medicaid claims effective January 1, 2026.
Action Required
By January 1, 2026: Billing team must verify updated prior authorization criteria for Targeted Immunomodulators, Agents for Thrombocytopenia, and Vykat XR on the Optum Rx Indiana Medicaid website before submitting PA requests. Update internal pharmacy prior authorization workflows to reflect new step therapy requirements for topical NSAIDs including diclofenac products. For Indiana Medicaid managed care patients, contact the specific MCE for PA requirements.