MedicaidCoverageMedium impact
[Indiana] Pharmacy Policy Updates - March 2026
CareSource·IN · Pharmacy, Internal Medicine, Hematology +5 more·Pharmacy
Effective date
May 1, 2026
We identified it
May 9, 2026
Summary
CareSource Indiana Medicaid is updating pharmacy policies effective May 1, 2026, affecting 22 specialty medications. Four new medications (Brinsupri, Forzinity, Gazyva, Jascayd, Papzimeos) are being added to formulary with new policies, eight existing medications have revised policies (including Benlysta, Immune Globulin, Koselugo, Lupkynis, Nitisinone, Nplate, Qalsody, Saphnelo), and ten medications are undergoing annual reviews with no coverage changes. The billing team must review individual policy details for each revised and new drug to understand updated prior authorization requirements, dosing limits, or clinical criteria.
Action Required
By April 24, 2026: Billing team and clinical staff must access each revised and new pharmacy policy via CareSource.com > Providers > Tools & Resources > Provider Policies, select Indiana Medicaid, then Pharmacy. For the 12 revised policies (Benlysta, Immune Globulin, Koselugo, Lupkynis, Nitisinone, Nplate, Qalsody, Saphnelo, Berinert, Kalbitor, Novantrone, Ofev, Oxlumo, Ruconest) and 5 new policies (Brinsupri, Forzinity, Gazyva, Jascayd, Papzimeos), document any changes to: (1) prior authorization requirements, (2) clinical criteria or step therapy protocols, (3) dosing or quantity limits, (4) age restrictions. Update billing system rules, EMR templates, and provider order entry systems accordingly. Providers must be notified of new policies before May 1, 2026. Failure to implement updates may result in claim denials or rejections for non-compliance with new clinical criteria.