Preferred Drug List – List of pre-approved drugs by the State
Indiana Medicaid Prior (Rx) Authorization Form
An Indiana Medicaid prior authorization form is a form used by medical professionals to request Medicaid coverage for a medication not listed on the state’s preferred drug list. The form provides the Office of Medicaid Policy and Planning with the patient’s diagnosis and the physician's explanation for why a non-preferred drug should be prescribed.
Updated November 12, 2024
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