MedicaidPrior AuthMedium impact
BT2025126: Pharmacy updates approved by Drug Utilization Review Board August 2025
Indiana Medicaid (IHCP)·IN · Psychiatry, Neurology, Pulmonology +6 more·Prior Authorization
Effective date
Oct 1, 2025
We identified it
Jun 18, 2026
Summary
Indiana Medicaid has updated prior authorization criteria for multiple drug categories, modified mental health medication utilization edits, and removed numerous brand-name drugs from the preferred drug list. These changes affect pharmacy coverage and require updated prior authorization processes.
Action Required
By October 1, 2025: Billing team must update prior authorization processes for affected drug categories including antimigraine agents, multiple sclerosis drugs, pulmonary antihypertensives, and mental health medications. Review current patient prescriptions against the removed SUPDL medications and coordinate with providers for alternative therapies. Update billing system to reflect new utilization limits for mental health medications effective November 1, 2025. Monitor claims for Indiana Medicaid patients to ensure compliance with new PA requirements.