Indiana FSSA Medicaid · October 27, 2026 · Primary source
BT2026164: IHCP updates pharmacy exclusion for Medicare-eligible members
Summary
Indiana IHCP Bulletin BT2026164, issued September 29, 2026, announces that effective October 1, 2026, Medicaid will no longer reimburse Medicare Part D-eligible prescriptions for members age 65 and 4 months or older who qualify for but are not enrolled in Medicare. A limited transition period through November 15, 2026 permits one-time 30-day authorizations for emergency supply fills, requiring pharmacy providers to call the member's assigned health plan or Optum Rx. Beginning November 16, 2026, Part D-eligible prescriptions are denied unless an exception is granted based on proof of Medicare application or denial.
What this may mean
Indiana pharmacy providers must obtain prior authorization for all Part D-eligible prescriptions dispensed to Medicare-eligible but unenrolled members between October 1 and November 15, 2026, and authorizations cover only emergency 30-day supplies. After November 15, 2026, pharmacies receive no Medicaid reimbursement for these prescriptions absent a documented FSSA exception. The policy affects FFS and managed care pathways, including Indiana PathWays for Aging MCOs.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
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