MedicaidPrior AuthHigh impact
BT2024189: Pharmacy updates approved by Drug Utilization Review Board November 2024
Indiana Medicaid (IHCP)·IN · Endocrinology, Neurology, Psychiatry +2 more·Prior Authorization
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
Indiana Medicaid has updated prior authorization requirements, preferred drug list status, and quantity limits for numerous medications effective January 1, 2025 (fee-for-service) and January 15, 2025 (managed care). Changes include new PA criteria for antiseizure agents, GLP-1 medications, and various drug formulary updates with step therapy requirements.
Action Required
By January 1, 2025: Pharmacy and billing teams must update prior authorization workflows for Indiana Medicaid patients. Review the updated PA criteria on the Optum Rx Indiana Medicaid website for antiseizure agents, GLP-1/GIP medications, growth hormones, movement disorder agents, and testosterone therapies. Update quantity limit settings in pharmacy management systems for affected medications including diazepam rectal (10 doses/30 days), Onyda XR (4 mL/day), and numerous insulin formulations. Train staff on new step therapy requirements for DPP-4 inhibitors and combination diabetes medications. Failure to obtain required prior authorizations will result in claim denials.