MedicaidPrior AuthLow impact
BT2025111: IHCP provides PA criteria for newly added physician-administered drug Tecelra (Q2057)
Indiana Medicaid (IHCP)·IN · Oncology, Hematology·Pharmacy
Effective date
Apr 1, 2025
We identified it
Jun 18, 2026
Summary
Indiana Medicaid has established prior authorization criteria for newly covered HCPCS code Q2057 (Tecelra), a specialized cancer treatment for adults with synovial sarcoma. The drug requires strict eligibility criteria including prior chemotherapy, specific genetic markers, and tumor expression testing.
Action Required
By next billing cycle: Billing team must update system to flag HCPCS code Q2057 for prior authorization requirements through Acentra Health (866-725-9991) before billing. Ensure all Q2057 claims include required NDC codes and use revenue code 636 for institutional outpatient claims. Submit FFS claims to Gainwell Technologies.