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Indiana Medicaid (IHCP)Medicaid · Coverage · Medical Policy · IN · Pulmonology, Infectious Disease, PediatricsMedium impact

BT202597: Coverage added for inhaled agent for cystic fibrosis Pulmozyme (J7639) under the IHCP medical benefit

Act
by Aug 1, 2025
Effective date
Aug 1, 2025
Identified
Jun 18, 2026

Summary

Indiana Health Coverage Programs (IHCP) is adding coverage for Pulmozyme (dornase alfa) under the medical benefit effective August 1, 2025, using HCPCS code J7639. This inhaled medication for cystic fibrosis will require prior authorization with the same criteria as the existing pharmacy benefit, including age 5+ and prescription by a specialist.

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What to do

by Aug 1, 2025 · 4 steps
01Billing team must update system to include HCPCS code J7639 for Pulmozyme with prior authorization requirement and NDC code requirement.
02Set maximum fee at $56.19.
03Ensure providers prescribing for cystic fibrosis patients age 5+ obtain prior authorization through pulmonologist, infectious disease specialist, or cystic fibrosis specialist.
04Update billing software to require NDC codes for all J7639 claims or they will be rejected.

Codes mentioned

J7639

Original notice

BT202597: Coverage added for inhaled agent for cystic fibrosis Pulmozyme (J7639) under the IHCP medical benefit
in.gov · Always check the source before changing claims.
View original ↗

Related policy hubs

Indiana Medicaid (IHCP) policiesIN policy changesPulmonologyInfectious DiseasePediatricsCode J7639

Summaries are AI-assisted. Always confirm against the original payer notice.

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