MedicaidPrior AuthMedium impact
BT2024137: Pharmacy updates approved by Drug Utilization Review Board August 2024
Indiana Medicaid (IHCP)·IN · Psychiatry, Neurology, Pulmonology +7 more·Prior Authorization
Effective date
Oct 1, 2024
We identified it
Jun 19, 2026
Summary
Indiana Medicaid has updated prior authorization criteria for multiple drug categories, changed preferred/non-preferred status for numerous medications on their drug formulary, and established new mental health utilization edits. These changes affect pharmacy billing and require updated prior authorization processes for specific medication categories.
Action Required
By October 1, 2024: Billing team must update pharmacy billing systems to reflect new prior authorization requirements for Adstiladrin, Antimigraine Agents, Antipsychotic Agents, Multiple Sclerosis Agents, Respiratory and Allergy Biologics, and Targeted Immunomodulators. Update preferred drug list status for all medications listed in Table 2. For managed care claims, implement changes by October 15, 2024. Review new step therapy requirements for systemic antifungals and vaginal antimicrobials. Failure to obtain required prior authorizations will result in claim denials.