MedicaidCoverageMedium impact
BT2021110: Drug coverage policy clarified for members enrolled in managed care requiring admission to LTC facilities
Indiana Medicaid (IHCP)·IN·Pharmacy
Effective date
Jan 1, 2022
We identified it
Jun 19, 2026
Summary
Starting January 1, 2022, Indiana Medicaid managed care entities must reimburse LTC pharmacy providers for all covered outpatient drugs and OTC medications, no longer considering these costs included in per diem rates. This aligns managed care reimbursement with fee-for-service processes for members in long-term care facilities.
Action Required
Effective January 1, 2022: LTC pharmacy providers must submit point-of-sale claims to MCE pharmacy benefit managers before dispensing medications. Billing teams should verify member MCE enrollment and submit claims through appropriate PBM systems. Ensure prior authorization requirements are met for covered drugs as MCEs may still apply utilization edits and PA criteria.