MedicaidCoverageHigh impact
[Indiana] Important Notice about Part D Drug Coverage
CareSource·IN · Pharmacy·Pharmacy
Effective date
Nov 1, 2026
We identified it
Sep 1, 2026
Summary
Effective November 1, 2026, CareSource will no longer reimburse for Medicare Part D drugs for Indiana Medicaid members who have both Medicare and Medicaid or who have opted out of Medicare Part D. Affected members will now be responsible for Medicare cost shares or copays instead of having these costs covered through their Medicaid benefit.
Action Required
By October 15, 2026: Billing team must update claim processing workflows to identify dual-eligible members (Medicare + Medicaid) and those who opted out of Part D, then route Part D drug claims to Medicare instead of Medicaid. Update billing system edits to prevent inappropriate Medicaid reimbursement for Part D drugs. Pharmacy staff must flag member accounts and ensure patients are informed of new copay/cost-share obligations before November 1. Contact CareSource Provider Services at 1-844-607-2831 (M-F, 8am-8pm ET/7am-7pm CT) with questions. Claims submitted after November 1 without proper Medicare routing will be denied by CareSource.