At the end of October, Indiana Health Coverage Programs (IHCP) released multiple updates that may impact your practice. To directly subscribe to receive updates, visit www.in.gov/medicaid/providers. 

Pharmacy updates approved by Drug Utilization Review Board
IHCP recently announced updates to the SilentAuth automated prior authorization (PA) system, PA criteria, Over-the-Counter (OTC) Drug Formulary, and Statewide Uniform Preferred Drug List (SUPDL) as approved by the Drug Utilization Review (DUR) Board at its Oct. 20 meeting.

Read all of the updates, including the addition of Naloxone and Narcan OTC nasal sprays to the formulary, in BT2023146.

IHCP allows reimbursement of cost sharing for dually eligible noncovered IHCP services
As announced in BT202313, the IHCP has begun enrollment for Medicare-only providers (provider type 37, specialty 370) that serve dually eligible (Medicare and Medicaid) members. These providers are only eligible to receive reimbursement for any applicable cost-sharing obligations for dually eligible IHCP members.

In addition to this new provider specialty, the IHCP modified its claim-processing logic for services covered by Medicare but not by the IHCP. For Qualified Medicare Beneficiary (QMB) dually eligible members, the IHCP will reimburse a member’s Medicare coinsurance and/or deductible amount for IHCP-noncovered professional or outpatient services. Providers will see an explanation of benefits (EOB) code 0885 – Provider payment of coinsurance and deductible for non-covered services – on impacted claims. This logic change impacts all IHCP providers.

For more, see BT2023147.

IHCP to cover weight-loss medications in select cases under EPSDT
IHCP may cover two weight-loss medications for eligible Medicaid members under the age of 21 through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. Wegovy (semaglutide) and Saxenda (liraglutide) have been approved by the Food and Drug Administration (FDA) for weight loss, and may be available for EPSDT-eligible members with an approved prior authorization.

Read more in BT2023148.

IHCP clarifies weekly reimbursement bundles for OTP services 
On July 1, IHCP replaced the per diem reimbursement bundle under the Healthcare Common Procedure Coding System (HCPCS) code H0020 with weekly reimbursement bundles that are currently being used by Medicare for the payment of opioid treatment program (OTP) services. This information was previously announced in IHCP Bulletin BT202357.

BT2023151 provides further clarification, including codes for take-home supplies and POS codes.