MedicaidAdministrativeMedium impact
BT202132: Pharmacies required to use Compound Ingredient Drug Cost field; reimbursement methodology updated
Indiana Medicaid (IHCP)·IN·Pharmacy
Effective date
Jun 1, 2021
We identified it
Jun 19, 2026
Summary
Effective June 1, 2021, Indiana Medicaid requires pharmacies to populate the Compound Ingredient Drug Cost field (449-EE) for all compound prescription claims and updates reimbursement methodology to use the lowest of NADAC, state MAC, provider charge, FUL, or WAC plus dispensing fees.
Action Required
By June 1, 2021: Pharmacy billing staff must ensure all compound prescription claims for Indiana Medicaid include the Compound Ingredient Drug Cost (449-EE) field in NCPDP Version D.0 transactions. Update pharmacy management system to require this field for compound claims. Review reimbursement calculations as methodology changed to lowest allowable cost structure. Claims missing this required field will likely be rejected.