MedicaidPrior AuthMedium impact
BT202014: Pharmacy updates approved by Drug Utilization Review Board February 2020
Indiana Medicaid (IHCP)·IN · Neurology, Psychiatry, Gastroenterology +4 more·Prior Authorization
Effective date
Apr 1, 2020
We identified it
Jun 19, 2026
Summary
Indiana Medicaid updates prior authorization requirements, preferred drug list status, and utilization edits for multiple medication classes including mental health drugs, antimigraine agents, multiple sclerosis agents, and others. Changes affect pharmacy benefits for fee-for-service Medicaid members.
Action Required
By April 1, 2020: Billing and clinical staff must review updated prior authorization criteria for Multiple Sclerosis Agents, Narcolepsy Agents, Antimigraine Agents, Hepatitis C Agents, Spinraza, and Buprenorphine on OptumRx Indiana Medicaid website. Update medication ordering protocols to reflect new preferred drug list changes and mental health utilization edits. Ensure Zulresso prescribers are enrolled in REMS program. Failure to obtain required prior authorizations will result in pharmacy claim denials.