MedicaidCoverageMedium impact
[Indiana] Pharmacy Policy Updates May 2026
CareSource·IN · Pharmacy, Oncology, Hematology +4 more·Pharmacy
Effective date
Jul 1, 2026
We identified it
May 9, 2026
Summary
CareSource Indiana Medicaid is updating 20 pharmacy policies effective July 1, 2026, including 6 new drug policies (AQVESME, EXDENSUR, KYGEVVI, LEROCHOL, MYQORZO, REDEMPLO, WASKYRA), 9 revised policies with updated clinical criteria, 2 archived policies (340B DRUG PRICING, KUVAN), and 3 policies with annual reviews but no clinical changes. The billing team must review each specific policy on CareSource.com to identify any prior authorization, coverage restrictions, or documentation requirements that may affect claim processing.
Action Required
By June 15, 2026: Billing team must access CareSource.com > Providers > Tools & Resources > Provider Policies, select Indiana Medicaid, then Pharmacy to review each of the 20 updated policies listed in this notification. For each NEW policy (AQVESME, EXDENSUR, KYGEVVI, LEROCHOL, MYQORZO, REDEMPLO, WASKYRA), document any prior authorization requirements, quantity limits, or step therapy protocols and add to billing system. For each REVISED policy, compare current system rules to updated requirements and modify prior auth rules, coverage criteria, or medical necessity documentation templates accordingly. For ARCHIVED policies (340B DRUG PRICING, KUVAN), remove from billing system coverage lists and ensure no claims are submitted under those policies after July 1, 2026. Update provider education materials and staff training on new coverage restrictions. Failure to implement updates may result in claim denials or incorrect reimbursement for affected specialty medications.