MedicaidCoverageMedium impact
BT2025186: Coverage added for physician-administered drug Photrexa (J2787) under the IHCP medical benefit
Indiana Medicaid (IHCP)·IN · Ophthalmology·Pharmacy
Effective date
Feb 1, 2024
We identified it
Jun 18, 2026
Summary
Indiana Medicaid (IHCP) is adding coverage for physician-administered Photrexa (J2787) effective immediately and retroactive to February 1, 2024. Prior authorization will be required starting January 30, 2026, for patients 14+ with unstable keratoconus or corneal ectasia diagnoses.
Action Required
Immediately: Billing team must update system to bill HCPCS code J2787 for Photrexa with required NDC for Indiana Medicaid patients. Add revenue code 636 for institutional outpatient claims. By January 30, 2026: Implement prior authorization requirements for patients 14+ with keratoconus or corneal ectasia diagnoses (H18.621-H18.623, H18.711-H18.712, H18.719). Update encounter forms to capture progression documentation beyond corrective lenses.