MedicaidPrior AuthMedium impact
BT202216: Pharmacy updates approved by Drug Utilization Review Board February 2022
Indiana Medicaid (IHCP)·IN·Prior Authorization
Effective date
Apr 1, 2022
We identified it
Jun 19, 2026
Summary
Indiana Medicaid updated prior authorization criteria for multiple drug classes, changed preferred drug list status for numerous medications, and modified utilization edits for mental health medications and vaccines, all effective April 1, 2022.
Action Required
By April 1, 2022: Pharmacy and billing teams must review updated prior authorization criteria on OptumRx Indiana Medicaid website for affected drug classes including Antimigraine Agents, Antipsychotics, Multiple Sclerosis Agents, and others. Update internal formularies to reflect PDL changes for drugs like Tudorza Pressair (now nonpreferred), Tezspire (nonpreferred), and new PA requirements. Verify age restrictions and quantity limits for vaccines before billing. Contact OptumRx Clinical Help Desk at 855-577-6317 for PA requests.