The Indiana Health Coverage Programs (IHCP) published multiple bulletins on March 28 that could impact Hoosier physician practices and their patients.

Pharmacy updates approved by DUR Board 
IHCP announced updates to the SilentAuth automated prior authorization (PA) system, PA criteria, and Over-the-Counter (OTC) Contraception Formulary as approved by the Drug Utilization Review (DUR) Board at its March 15 meeting.

IHCP has enhanced its automated PA system to update the criteria for the Respiratory and Allergy Biologics prior authorizations. These PA changes will be effective for PA requests submitted on or after May 1. The PA criteria are posted on the Pharmacy Prior Authorization Criteria and Forms page.

The DUR Board also established and approved PA criteria for Non-SUPDL PA and Step Therapy at its meeting. These criteria apply to the fee-for-service (FFS) benefit. These PA changes will be effective for PA requests submitted on or after May 1. The PA criteria are posted on the Pharmacy Prior Authorization Criteria and Forms page on the Optum Rx Indiana Medicaid website.

Finally, an update was made to the OTC Contraception Formulary. Opill (norgestrel) is now a covered product. The formulary change will be effective for FFS claims with dates of service (DOS) on or after May 1, and managed care claims with DOS on or after May 15.

Read more in BT202436.

Coverage information for the April 2024 quarterly HCPCS update
IHCP has reviewed the April 2024 quarterly Healthcare Common Procedure Coding System (HCPCS) update to determine coverage determination. IHCP coverage information in Table 1 is effective for DOS on or after April 1, 2024.

The IHCP is awaiting the final posting of the Centers for Medicare & Medicaid Services (CMS) fee schedules and documentation affecting coverage and pricing for the procedure codes. After the final review is completed, IHCP will issue a publication detailing the additional coverage and pricing information.

Read more in BT202437.

2024 IHCP Roadshow planned for April 30 to June 6
The 2024 IHCP Roadshow will be held at six locations throughout the state of Indiana, starting April 30 and concluding June 6.

These events will allow for face-to-face discussion of current and future initiatives by the Indiana Family and Social Services Administration (FSSA), Gainwell Technologies and all of IHCP’s business partners. This year’s IHCP Roadshow will include special programming specifically on the launch of the Indiana PathWays for Aging program and programming related to existing programs, payers and providers.

View the full schedule in BT202438.