MedicaidCoverageHigh impact
[Indiana] Pharmacy Policy Updates May 2025
CareSource·IN · Pharmacy, Oncology, Ophthalmology +7 more·Pharmacy
Effective date
Jun 30, 2025
We identified it
May 9, 2026
Summary
CareSource Indiana Medicaid is updating pharmacy policies for 38 medications effective June 30, 2025. Changes include 15 new policies, 20 revised policies, 2 archived policies, and 4 policies that now follow Fee-for-Service prior authorization criteria. Billing teams must verify coverage and prior authorization requirements for each affected drug before claims submission.
Action Required
By June 29, 2025: Billing team must access CareSource.com > Providers > Tools & Resources > Provider Policies, select Indiana Medicaid, and review all 38 pharmacy policies in detail to identify specific prior authorization requirements, coverage limitations, and billing code implications for each drug. Create internal reference guide mapping medications to new/revised requirements. Identify which medications in current patient cases are affected and flag for provider review. For the 4 medications now following Fee-for-Service prior authorization criteria (BKEMV, EPYSQLI, AQNEURSA, MIPLYFFA, ATTRUBY, VYNDAQEL/VYNDAMAX), obtain prior authorization before dispensing. Update pharmacy billing system and prior authorization workflow to reflect new policy status for each drug. Train billing staff on new policies before effective date. Failure to follow updated policies may result in claim denials.