MedicaidPrior AuthMedium impact
BT2020105: Pharmacy updates approved by Drug Utilization Review Board September 2020
Indiana Medicaid (IHCP)·IN · Neurology, Pediatrics, PM&R (Physical Medicine & Rehab)·Prior Authorization
Effective date
Nov 1, 2020
We identified it
Jun 19, 2026
Summary
Indiana Medicaid established new prior authorization requirements for Spinal Muscular Atrophy (SMA) Agents and Muscular Dystrophy Agents effective November 1, 2020. Providers must obtain prior authorization before prescribing these specialized medications for fee-for-service Medicaid patients.
Action Required
Before November 1, 2020: Billing team and providers must implement prior authorization workflow for SMA and Muscular Dystrophy medications. Review PA criteria on OptumRx Indiana Medicaid website via in.gov/medicaid/providers. Train staff to submit PA requests to OptumRx Clinical and Technical Help Desk at 1-855-577-6317 for fee-for-service patients before prescribing these medications. Claims will be denied without proper prior authorization.