MedicaidPrior AuthHigh impact
BT202538: Pharmacy updates approved by the Office of Medicaid Policy and Planning February 2025
Indiana Medicaid (IHCP)·IN · Family Medicine, Internal Medicine, Pediatrics +5 more·Pharmacy
Effective date
Apr 15, 2025
We identified it
Jun 19, 2026
Summary
Indiana Medicaid updates pharmacy prior authorization criteria, mental health utilization edits, and preferred drug lists effective April 15, 2025 for fee-for-service and May 1, 2025 for managed care. Changes include new PA requirements for multiple drug classes, updated quantity limits for mental health medications, and revised preferred drug status for various medications.
Action Required
By April 15, 2025: Pharmacy and billing teams must update prior authorization workflows for Antimigraine Agents, GLP-1 RA/GIP RA/Combination Agents, Multiple Sclerosis Agents, Respiratory and Allergy Biologics, Targeted Immunomodulators, Cystic Fibrosis Agents, Niemann-Pick Disease Agents, and Transthyretin Stabilizer Agents. Review and implement new mental health medication quantity limits including clonidine patches and Erzofri injectables. Update preferred drug lists and step therapy requirements for DPP-4 and SGLT inhibitors to verify patients are not on concurrent GLP-1 therapy. Download updated PA criteria from OptumRx Indiana Medicaid website. Claims submitted without proper authorization or exceeding new quantity limits will be denied.