MedicaidCoverageHigh impact
BT2024135: Pharmacy coverage changes for COVID-19 services upon ARP and PREP Act expiration
Indiana Medicaid (IHCP)·IN · Family Medicine, Internal Medicine, Pediatrics·Pharmacy
Effective date
Oct 1, 2024
We identified it
Jun 19, 2026
Summary
Indiana Health Coverage Programs (IHCP) is implementing major changes to COVID-19 pharmacy coverage effective October 1, 2024, including discontinuation of at-home COVID-19 test coverage through pharmacy benefit, end of ARP cost-share removal for treatments, and transition of COVID-19 vaccines to managed care plans starting January 1, 2025. Reimbursement for non-FDA approved COVID-19 treatments will also stop.
Action Required
By October 1, 2024: Billing team must stop processing at-home COVID-19 test claims through pharmacy benefit and redirect to medical benefit. Update system to reinstate cost-sharing for COVID-19 treatments. Stop billing for non-FDA approved COVID-19 treatments. By January 1, 2025: Transition COVID-19 vaccine claims for HIP, Hoosier Healthwise, Hoosier Care Connect, and PathWays members to process through their respective managed care entity's pharmacy benefit instead of fee-for-service.