MedicaidPrior AuthMedium impact
BT202390: Pharmacy updates approved by Drug Utilization Review Board July 2023
Indiana Medicaid (IHCP)·IN · Family Medicine, Internal Medicine, General Practice +2 more·Prior Authorization
Effective date
Sep 1, 2023
We identified it
Jun 19, 2026
Summary
Indiana Medicaid updated prior authorization requirements and age limits for several proton pump inhibitors, modified vaccine coverage rules, and enhanced opioid overutilization criteria. Key changes include new step therapy requirements for PPIs and updated quantity limits for various medications and vaccines.
Action Required
By September 1, 2023: Billing team must update prior authorization workflows for Indiana Medicaid patients receiving proton pump inhibitors (esomeprazole packets, rabeprazole sprinkle, lansoprazole ODT, pantoprazole packets, Prilosec packets, Konvomep oral suspension, omeprazole/sodium bicarb powder, Zegerid powder). Update system to reflect new age limits and step therapy requirements. Remove quantity limits for COVID-19 bivalent vaccines and update pneumococcal and RSV vaccine billing rules. Contact OptumRx Clinical Help Desk at 855-577-6317 for specific PA questions.