The Indiana Health Coverage Programs (IHCP) recently sent updates to health care providers concerning prior authorization (PA).
BT2023182, “Coverage and billing information for the 2024 annual HCPCS codes update,” was corrected by IHCP. Procedure code J0576 (injection, buprenorphine extended-release (brixadi), 1 mg) will now require PA. The PA criteria for J0576 will be announced in an upcoming bulletin.
In
BT202409, “Pharmacy updates approved by Drug Utilization Review Board January 2024,” IHCP announced updates to the SilentAuth automated PA system, PA criteria, Statewide Uniform Preferred Drug List (SUPDL) and Over-the-Counter (OTC) Pharmacy Supplements Formulary as approved by the Drug Utilization Review (DUR) Board at its Jan. 19, 2024, meeting.
SilentAuth PA enhancement
The IHCP has enhanced its automated PA system to update the criteria for the GLP-1 Receptor Agonists and Combinations and Opioid Overutilization PA with QL PAs. These PA changes will be effective for fee-for-service (FFS) PA requests submitted on or after March 1 and managed care PA requests submitted on or after March 15. The PA criteria are posted on the Pharmacy Prior Authorization Criteria and Forms page on the Optum Rx Indiana Medicaid website, accessible from the Pharmacy Services page at
www.in.gov/medicaid/providers.
PA Changes
PA criteria for Immunoglobulin A Nephropathy Agents, Non-Drug Specific PA, Urea Cycle Disorders, and Non-SUPDL PA and Step Therapy were established and approved by the DUR Board. PA criteria for Immunoglobulin A Nephropathy Agents and Non-SUPDL PA and Step Therapy apply to the FFS benefit. These PA changes will be effective for PA requests submitted on or after March 1. The PA criteria are posted on the Pharmacy Prior Authorization Criteria and Forms page on the
Optum Rx Indiana Medicaid website.
Changes to the SUPDL
Changes to the SUPDL were also made at DUR Board meeting.
See Table 1 for a summary of SUPDL changes. SUPDL changes will be effective for FFS claims with dates of service (DOS) on or after March 1 and managed care claims with DOS on or after March 15.