MedicaidPrior AuthMedium impact
BT2024186: IHCP revises coverage and PA requirements for physician-administered drugs
Indiana Medicaid (IHCP)·IN · Rheumatology, Endocrinology, Gastroenterology +1 more·Medical Policy
Effective date
Nov 21, 2024
We identified it
Jun 19, 2026
Summary
Indiana Medicaid (IHCP) is adding coverage for three new physician-administered drugs (rilonacept and two adalimumab biosimilars) with retroactive coverage dating back to 2022-2024, and implementing prior authorization requirements for these drugs plus lanreotide injections effective November 21, 2024.
Action Required
Immediately: Billing team must update systems to require prior authorization for codes J2793, Q5131, Q5132, J1930, and J1932 for all Indiana Medicaid claims with dates of service on or after November 21, 2024. Ensure all claims include required NDC codes and use revenue code 636 for institutional outpatient claims. Submit retroactive claims within 90 days (managed care) or 180 days (fee-for-service) with copy of bulletin attached. Access PA criteria on Optum Rx Indiana Medicaid website under Targeted Immunomodulators and Somatostatin Analogs sections.