IHCP removes cost-sharing obligations for pharmacist-administered adult vaccines; updates pharmacy benefit LARC coverage
The Indiana Health Coverage Programs (IHCP) recently issued two updates that could impact ISMA physicians and/or their patients. 

Cost-sharing obligations for pharmacist-administered adult vaccines removed
 To improve vaccination rates and help reduce morbidity, hospitalizations and deaths among the adult population, amendments were made to Section 11405 of the Inflation Reduction Act (IRA) requiring Medicaid and Children’s Health Insurance Program (CHIP) programs to cover U.S. Food and Drug Administration (FDA)-approved vaccines recommended by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) and their administration with no member cost-sharing.

Effective for dates of service (DOS) on and after Oct. 1, the IHCP will remove member cost-sharing obligations for all FDA-approved, ACIP-recommended adult vaccines on claims processed through the pharmacy benefit. As established in IHCP Bulletins BT201564 and BT201823, the IHCP will reimburse IHCP-enrolled pharmacy providers for pharmacist-administered vaccines when provided to eligible IHCP members 19 years of age and older. Coronavirus disease 2019 (COVID-19) vaccination reimbursement is currently carved out of the managed care benefits. 

Read more in BT2023107.

LARC coverage updated
 IHCP recently updated long-acting reversible contraceptive (LARC) coverage to comply with Indiana Code IC-12-15-47. Under the new law, LARC intrauterine devices and birth control implants obtained for a Medicaid recipient may be transferred to another Medicaid recipient if the LARC was not delivered to, implanted in or used on the original Medicaid recipient to whom the LARC was prescribed if the LARC product meets the following conditions: 

  • Be in the original, unopened package.
  • Have been in the possession of the provider for at least 12 weeks. However, the requirement under this subdivision may be waived by the written consent of the original Medicaid recipient to whom the LARC was prescribed.
  • Not have left the possession of the provider that originally prescribed the LARC.
  • Be medically appropriate and not contraindicated for the Medicaid recipient to whom the LARC is being transferred.

For dates of service on or after Oct. 1, IHCP will reimburse LARC claims through the pharmacy benefit for IHCP-enrolled pharmacies meeting the resale, reuse or redistribution requirements set forth in IC 25-26-13-25 only. Claims for transferred LARC products will need to be reversed for the original Medicaid recipient and resubmitted for the Medicaid recipient to whom the product is being transferred. Pharmacy providers that do not meet IC 25-26-13-25 requirements for dispensing returned products will no longer be reimbursed for LARC claims. The IHCP will continue to reimburse IHCP-enrolled providers for LARC claims submitted through the medical benefit.

Read more in BT2023111.