MedicaidReimbursementMedium impact
BT202518: IHCP changes the blood factor maximum allowable cost multiplier
Indiana Medicaid (IHCP)·IN · Hematology, Oncology·Provider Bulletin
Effective date
Mar 6, 2025
We identified it
Jun 19, 2026
Summary
Indiana Medicaid is reducing the maximum allowable cost multiplier for outpatient blood factor products from 1.18 to 1.05, effective March 6, 2025. This will result in lower reimbursement rates for blood factor products dispensed to Indiana Medicaid patients.
Action Required
Before March 6, 2025: Billing team must update financial expectations for blood factor product reimbursements from Indiana Medicaid patients. Review current blood factor inventory and pricing strategies. Monitor updated MAC rates on the Optum Rx Indiana Medicaid website when published. Ensure all blood factor claims continue to be submitted to Gainwell Technologies (professional/institutional) or Optum Rx (pharmacy) as carved-out services.