MedicaidCoverageMedium impact
BT2026144: Pharmacy updates approved by Drug Utilization Review Board August 2026
Indiana Medicaid (IHCP)·IN · Endocrinology, Cardiology, Nephrology +5 more·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Aug 28, 2026
Summary
Indiana Health Coverage Programs (IHCP) has updated pharmacy coverage policies effective November 1, 2026, including new prior authorization criteria for multiple drug classes, changes to preferred drug status for 6 medications (including moving Farxiga to nonpreferred and dapagliflozin generic to preferred), and updates to the Preferred Brand Drug List adding 5 medications and removing 5 medications. Billing teams must verify patient drug coverage and obtain prior authorizations where required starting November 1, 2026.
Action Required
By October 15, 2026: Billing team and pharmacy staff must review policy changes and update internal drug formulary references. (1) Update billing system and pharmacy software to reflect new SUPDL preferred/nonpreferred status changes, particularly: Xocova (add age/quantity limits), mesalamine ER generic (nonpreferred), Farxiga brand (nonpreferred), dapagliflozin generic (preferred), Cosopt PF (preferred), dorzolamide/timolol generic (nonpreferred). (2) Add new Preferred Brand Drug List medications to system: Cosopt PF, Janumet XR, Nuedexta, Pentasa ER, Rhofade. (3) Remove from Preferred Brand Drug List: Farxiga, Fycompa, Ravicti, Zituvio, Zituvimet. (4) Implement prior authorization requirements for FFS claims (effective date Nov 1, 2026) for: Amyloid Beta-Directed Antibodies, Hepcludex, IgAN Agents, Non-Drug-Specific PA, PCSK9 Inhibitors, and Select Lipotropics. (5) Contact Optum Rx Clinical Help Desk (855-577-6317) with questions about PA criteria specifics. (6) For managed care enrollees, verify MCO-specific PA requirements separately. (7) Communicate drug status changes to prescribing providers to avoid claim denials and prior authorization delays. Claims submitted on or after Nov 1, 2026 with incorrect drug status or missing required prior authorization will be denied.