MedicaidPrior AuthMedium impact
BT2024102: IHCP updates PA criteria for HCPCS codes Q2054 (Breyanzi) and Q2055 (Abecma)
Indiana Medicaid (IHCP)·IN · Oncology, Hematology·Claims & Billing
Effective date
Mar 15, 2024
We identified it
Jun 19, 2026
Summary
IHCP has updated prior authorization criteria for CAR-T cell therapies Breyanzi (Q2054) and Abecma (Q2055), adding specific eligibility requirements including age restrictions, diagnosis criteria, prior treatment history, and facility certification requirements. These therapies are carved out from managed care and processed through fee-for-service delivery.
Action Required
Immediately: Review updated PA criteria for Q2054 (Breyanzi) and Q2055 (Abecma). Ensure all PA requests include documentation of age 18+, specific diagnosis codes, prior treatment history, and REMS-certified facility administration. Submit all PA requests to Acentra Health at 866-725-9991, not managed care entities. Claims must be submitted to Gainwell Technologies FFS system.