MedicaidPrior AuthMedium impact
BT202162: Pharmacy updates approved by Drug Utilization Review Board July 2021
Indiana Medicaid (IHCP)·IN·Prior Authorization
Effective date
Sep 1, 2021
We identified it
Jun 19, 2026
Summary
Indiana Medicaid will require prior authorization for compounded prescription claims with charges of $500 or more starting September 1, 2021. This applies only to fee-for-service Medicaid pharmacy benefits.
Action Required
Before September 1, 2021: Billing team must update workflow to obtain prior authorization for all compounded prescriptions costing $500 or more for Indiana Medicaid fee-for-service patients. Access PA criteria and forms at OptumRx Indiana Medicaid website via in.gov/medicaid/providers. For PA requests, call OptumRx Clinical and Technical Help Desk at 855-577-6317. Claims submitted without required PA will be denied.