When does this change take effect?

This change is effective Jun 1, 2024.

MedicaidPrior AuthMedium impact

BT202454: Pharmacy updates approved by Drug Utilization Review Board April 2024

Q: Who is affected by this change?

This affects Indiana Medicaid (IHCP) Endocrinology, Allergy & Immunology, Gastroenterology, Infectious Disease, Pulmonology providers in IN on Medicaid plans.

Indiana Medicaid (IHCP)·IN · Endocrinology, Allergy & Immunology, Gastroenterology +2 more·Prior Authorization

Effective date

Jun 1, 2024

We identified it

Jun 19, 2026

Days to comply

—

Summary

Indiana Medicaid has updated prior authorization criteria for GLP-1 RA medications, respiratory/allergy biologics, and established new PA requirements for MASH/MASLD and Hepatitis B agents. These changes affect automated prior authorization processing and manual PA requests.

Action Required

Action needed

By June 1, 2024: Billing team must review updated prior authorization criteria on the Optum Rx Indiana Medicaid website for GLP-1 RA medications, respiratory/allergy biologics, MASH/MASLD agents, and Hepatitis B agents. Update billing system PA requirements and staff workflows accordingly. Direct PA questions to Optum Rx Clinical Help Desk at 855-577-6317 for fee-for-service patients, or to appropriate MCE for managed care patients.

Related policy hubs

Indiana Medicaid (IHCP) policies IN policy changes Endocrinology Allergy & Immunology Gastroenterology Infectious Disease Pulmonology