MedicaidCoverageMedium impact
BT202495: IHCP adds coverage for Hemgenix treatment
Indiana Medicaid (IHCP)·IN · Hematology·Medical Policy
Effective date
Jun 1, 2023
We identified it
Jun 19, 2026
Summary
IHCP (Indiana Medicaid) now covers Hemgenix (etranacogene dezaparvovec-drlb) gene therapy for hemophilia B patients 18+ years old using HCPCS code J1411, effective June 1, 2023. This expensive treatment ($3.675M max fee) requires prior authorization and is limited to one unit per member per lifetime.
Action Required
Immediately: Billing team must update system to require prior authorization for HCPCS J1411 (Hemgenix) and NDC codes when billing Indiana Medicaid patients. Contact Acentra Health at 866-725-9991 for prior auth requests. Ensure claims are submitted to Gainwell Technologies at 800-457-4584. Limited to patients 18+ years old and one unit per lifetime. Failure to obtain prior auth will result in claim denials.