MedicaidPrior AuthMedium impact
BT202643: IHCP updates PA requirements for certain physician-administered drugs
Indiana Medicaid (IHCP)·IN · Endocrinology, Neurology, Pediatrics +1 more·Provider Bulletin
Effective date
Apr 24, 2026
We identified it
Jun 18, 2026
Summary
Indiana Medicaid (IHCP) is implementing prior authorization requirements for two physician-administered drugs: avalglucosidase alfa (Nexviazyme) and alglucosidase alfa (Lumizyme) under fee-for-service medical benefits. Prior authorization will be required for HCPCS codes J0219 and J0221 starting April 24, 2026.
Action Required
Before April 24, 2026: Billing team must update prior authorization workflows for HCPCS codes J0219 (Nexviazyme injection) and J0221 (Lumizyme injection) for Indiana Medicaid fee-for-service patients. Contact Acentra Health at 866-725-9991 to request medical benefit prior authorizations. Update billing system alerts and provider encounter forms to prompt for PA before administering these drugs. Claims without prior authorization will be denied.