Starting December 1, 2026, Iowa Medicaid is transitioning its pharmacy benefit away from the Managed Care Organizations (MCOs) to Fee-for-Service (FFS). The FFS single statewide pharmacy vendor is Optum Rx.
This change will apply to all Iowa Medicaid members and how their outpatient prescription drugs are billed by pharmacies at the point of sale.
List items for Eligibility / Member Questions - Medicaid Pharmacy
No.
No.
Yes. If you are enrolled currently, you will still be enrolled with the MCO for medical care and services.
Yes. You can tell the pharmacy you are an Iowa Medicaid member and provide the necessary person information for the pharmacist to confirm eligibility with HHS.
No. You can still get your medications at your existing pharmacy.
List items for Provider Questions - Medicaid Pharmacy
No. If you are enrolled with Iowa Medicaid you will not need to enroll separately with Optum Rx.
Optum Rx is only operating Iowa Medicaid’s outpatient pharmacy benefit.
Anything on the medical benefit will need to be submitted to the member’s medical benefit, either through an MCO or FFS. Vaccines, physician administered drugs, and durable medical equipment, such as wheelchairs and diabetic supplies, will continue to be billed on the member’s medical benefit.
Beginning December 1, 2026, all pharmacy prior authorization requests will need to be submitted to Optum Rx.
The fax number is 1-800-574-2515.
The Optum Rx Prior Authorization Help Desk can be reached at 1-877-776-1567 or 515-256-4607 (local).
Yes. If the PA expired after 12/01/2026, a new PA may be required.
Yes. You will receive an updated card from your MCO without pharmacy processing information on it.
Anything that is billed on the medical benefit, which includes but is not limited to physician administered drugs/medications, vaccines, and durable medical equipment (DME).
No. The carve-out is specific to outpatient prescribed drugs on the pharmacy benefit. Physician-administered drugs, vaccines, and DME will remain on the medical benefit with Managed Care.
Members should tell their pharmacy to bill Iowa Medicaid and present their State of Iowa Medicaid Eligibility Card.
ID: Member’s Medicaid ID #
BIN: 011933
PCN: IAPOP
Effective Date: 12/01/2026
No. The State will not be issuing a new member card specific to the outpatient pharmacy benefit.
Optum Rx is only operating Iowa Medicaid’s outpatient pharmacy benefit.
Anything on the medical benefit will need to be submitted to the member’s medical benefit, either through an MCO or FFS.
Vaccines, physician administered drugs, and durable medical equipment, such as wheelchairs and diabetic supplies, will continue to be billed on the member’s medical benefit.
List items for Prior Authorizations - Medicaid Pharmacy
Fee-for-Service (FFS) (Optum Rx) will honor all active prior authorizations from the MCOs that span across dates beyond December 1, 2026.
FFS will honor these prior authorizations for the life of the PA which was approved by the MCOs.
No. Providers will not have to complete a new prior authorization for a member in which the prior authorization was approved by the member’s MCO prior to December 1, 2026.
Effective December 1, 2026, all pharmacy prior authorizations will be submitted to and reviewed by Optum Rx.
Contact Information
Fee-for-Service (FFS) Pharmacy Contact Information
Effective December 1, 2026
Members
FFS Member Services: 1-800-338-8366 or 515-256-4606 (local)
Providers
Optum Rx Point-of-Sale Support: 1-877-463-7671 or 515-256-4608 (local)
