MedicaidCoverageHigh impact
BT202685: IHCP announces pharmacy exclusion for Medicare-eligible members
Indiana Medicaid (IHCP)·IN·Pharmacy
Effective date
Oct 1, 2026
We identified it
Jun 18, 2026
Summary
Effective October 1, 2026, Indiana Medicaid will stop covering Medicare Part D-eligible prescriptions for members aged 65+ months who qualify for but are not enrolled in Medicare. These members must enroll in Medicare by October 1, 2026, or Medicaid will no longer pay for their prescription drugs.
Action Required
By October 1, 2026: Billing team must implement verification process to confirm Medicare enrollment status for all Medicaid members aged 65+ months before billing prescription claims. Update billing system to flag these members and verify Medicare Part D coverage before submitting Medicaid pharmacy claims. After October 1, 2026, Medicaid will recoup payments for Part D-eligible prescriptions billed to Medicaid for qualifying members not enrolled in Medicare.