MedicaidCoverageMedium impact
[Indiana] Pharmacy Policy Updates January 2026
CareSource·IN · Pharmacy, Hematology, Oncology +4 more·Pharmacy
Effective date
Jan 1, 2026
We identified it
May 9, 2026
Summary
CareSource Indiana Medicaid has updated pharmacy policies effective January 1, 2026, affecting 26 specialty medications across rare disease and specialty drug categories. This includes 3 new policy additions (Andembry, Ekterly, Sylvant, Yeztugo) and 22 revised policies for existing specialty drugs, plus 1 archived policy (Yutiq). Billing teams must review individual policy documents to identify specific prior authorization, coverage limitations, and documentation requirements for each medication.
Action Required
By January 1, 2026: Billing and pharmacy teams must access the full policy documents for each of the 26 affected medications via CareSource.com > Providers > Tools & Resources > Provider Policies > Indiana Medicaid > Pharmacy to identify specific prior authorization requirements, coverage criteria, and any billing code changes. Update clinical and billing workflows to reflect new coverage policies for Andembry, Ekterly, Sylvant, and Yeztugo (new policies), and verify revised requirements for all 22 existing specialty drugs. Remove Yutiq from covered medication lists. Ensure providers and pharmacy staff are aware of requirements before dispensing to avoid claim denials. This notification does not provide specific billing codes or detailed coverage rules—individual policy documents must be reviewed for actionable billing changes.