MedicaidPrior AuthMedium impact
BT2025117: Pharmacy updates approved by the Office of Medicaid Policy and Planning August 2025
Indiana Medicaid (IHCP)·IN · Rheumatology, Gastroenterology, Dermatology·Pharmacy
Effective date
Oct 1, 2025
We identified it
Jun 18, 2026
Summary
Indiana Medicaid updated its preferred drug list for targeted immunomodulators, making adalimumab-adaz (unbranded Hyrimoz) preferred while downgrading Humira and other adalimumab products to nonpreferred status. The automated prior authorization criteria for targeted immunomodulators was also enhanced.
Action Required
Before October 1, 2025: Billing team must review updated prior authorization criteria for targeted immunomodulators on the Optum Rx Indiana Medicaid website. Update pharmacy benefit protocols to reflect new preferred drug status - prioritize adalimumab-adaz (unbranded Hyrimoz) over Humira and other adalimumab products for Indiana Medicaid patients. For prior authorization questions, contact Optum Rx Clinical and Technical Help Desk at 855-577-6317.