MedicaidAdministrativeMedium impact
BT202416: IHCP announces updated billing guidance for Paxlovid pharmacy claims
Indiana Medicaid (IHCP)·IN · Family Medicine, Internal Medicine, General Practice +2 more·Pharmacy
Effective date
Feb 15, 2024
We identified it
Jun 19, 2026
Summary
IHCP updated billing guidance for Paxlovid pharmacy claims, establishing that covered entities in the 340B program must stop billing IHCP using 340B product effective February 15, 2024, and instead use the PAXCESS Patient Support Program. The policy also clarifies that IHCP will collect manufacturer rebates on commercial Paxlovid products and provides updated COVID-19 vaccine reimbursement at geographically adjusted Medicare rates.
Action Required
By February 15, 2024: Pharmacy teams at 340B covered entities must stop billing IHCP using 340B product for Paxlovid claims and direct patients to use the PAXCESS Patient Support Program instead by visiting https://paxlovid.iassist.com/attestation or calling 877-219-7225. Submit claims for emergency use authorization Paxlovid products only for dispensing fee reimbursement. For COVID-19 vaccine claims with dates of service September 11, 2023 or later, verify reprocessing occurs for correct reimbursement at updated Medicare rates.