MedicaidPrior AuthMedium impact
BT2025134: Pharmacy updates approved by Drug Utilization Review Board September 2025
Indiana Medicaid (IHCP)·IN · Neurology, Endocrinology, Hematology +1 more·Prior Authorization
Effective date
Dec 1, 2025
We identified it
Jun 18, 2026
Summary
Indiana Medicaid has updated prior authorization criteria for multiple drug classes including Multiple Sclerosis medications, GLP-1 agents, and others, while changing the preferred status of several medications including Ampyra and bosentan dispersible tablets. These changes affect both fee-for-service and managed care Medicaid claims.
Action Required
Before December 1, 2025: Billing team must update prior authorization procedures for Multiple Sclerosis medications, Amyloid-Beta-Directed Antibodies, Complement Inhibitor Agents, Cushing's Syndrome Agents, GLP-1 RA/GIP RA/Combination Agents, Phenylketonuria Agents, and Thrombopoietin Receptor Agonist Agents. Update pharmacy billing system to reflect that Ampyra (dalfampridine) brand and bosentan dispersible tablet generic are now nonpreferred. Review PA criteria on OptumRx Indiana Medicaid website. Failure to obtain required prior authorizations will result in claim denials.