MedicaidCoverageMedium impact
BT2023148: IHCP to cover weight-loss medications in select cases under EPSDT
Indiana Medicaid (IHCP)·IN · Endocrinology, Pediatrics, Family Medicine +1 more·Specialty Services
Effective date
Oct 31, 2023
We identified it
Jun 19, 2026
Summary
Indiana Medicaid (IHCP) will now cover weight-loss medications Wegovy and Saxenda for members under age 21 through the EPSDT program with prior authorization. Providers must submit PA requests using generic codes J3490, J3590, or C9399 while specifying the exact drug name in the authorization process.
Action Required
Immediately: Billing team must update procedures for weight-loss medication claims for Indiana Medicaid members under 21. When prescribing Wegovy or Saxenda, submit prior authorization requests through Kepro's Atrezzo Provider Portal using codes J3490, J3590, or C9399, ensuring the specific drug name is selected in the questionnaire. Include documentation of morbid obesity diagnosis with comorbidities, nutritional counseling attempts, and previous weight-loss interventions. Set up 6-month reassessment reminders for continued authorization.