MedicaidPrior AuthMedium impact
BT202559: Pharmacy updates approved by the Office of Medicaid Policy and Planning April 2025
Indiana Medicaid (IHCP)·IN · Allergy & Immunology, Oncology, Hematology +3 more·Pharmacy
Effective date
Jun 15, 2025
We identified it
Jun 18, 2026
Summary
Indiana Medicaid has updated prior authorization criteria for four drug categories (Allergy-Specific Immunotherapy, Complement Inhibitor Agents, Niemann-Pick Disease, and Opioid Use Disorder Treatments) and added two medications to the Preferred Brand Drug List (Brilinta 90mg and Sandostatin LAR 10mg). These changes affect both fee-for-service and managed care Medicaid claims with different effective dates.
Action Required
By June 15, 2025: Billing team must update prior authorization procedures for Allergy-Specific Immunotherapy, Complement Inhibitor Agents, Niemann-Pick Disease, and Opioid Use Disorder medications for Indiana Medicaid fee-for-service patients. Update pharmacy billing system to reflect Brilinta 90mg and Sandostatin LAR 10mg as preferred brand drugs. For managed care patients, implement Preferred Brand Drug List changes by June 30, 2025. Download updated PA criteria from Optum Rx Indiana Medicaid website to ensure compliance.