MedicaidPrior AuthMedium impact
BT202125: Pharmacy updates approved by Drug Utilization Review Board March 2021
Indiana Medicaid (IHCP)·IN · Neurology, Pediatrics, PM&R (Physical Medicine & Rehab)·Prior Authorization
Effective date
May 1, 2021
We identified it
Jun 19, 2026
Summary
Indiana Medicaid has established new prior authorization requirements for Muscular Dystrophy Agents, effective May 1, 2021. This affects fee-for-service pharmacy benefits and requires prior authorization before dispensing these medications.
Action Required
Before May 1, 2021: Billing team and providers must obtain prior authorization through OptumRx for all Muscular Dystrophy Agent prescriptions for Indiana Medicaid fee-for-service patients. Review PA criteria on OptumRx Indiana Medicaid website and update workflow to check authorization before dispensing. Contact OptumRx Clinical and Technical Help Desk at 1-855-577-6317 for PA requests.