MedicaidPrior AuthMedium impact
BT202134: Pharmacy updates approved by Drug Utilization Review Board April 2021
Indiana Medicaid (IHCP)·IN · Pulmonology, Pediatrics, Family Medicine +1 more·Prior Authorization
Effective date
Jun 1, 2021
We identified it
Jun 19, 2026
Summary
Indiana Medicaid has established new prior authorization criteria for Cystic Fibrosis Agents effective June 1, 2021. This affects fee-for-service pharmacy benefits and requires prior authorization for cystic fibrosis medications.
Action Required
Before June 1, 2021: Billing team must implement prior authorization requirements for all Cystic Fibrosis Agent prescriptions for Indiana Medicaid FFS patients. Review PA criteria on OptumRx Indiana Medicaid website and update pharmacy billing workflows to obtain prior auth before dispensing. Contact OptumRx Clinical Help Desk at 1-855-577-6317 for PA requests.