The prescription drug benefit for Care Select members in the MDwise plan include those legend drug products that are listed on the IHCP preferred drug list and over-the-counter (OTC) drug products listed on the State of Indiana OTC Drug Formulary. Legend drug products that are non-preferred require prior authorization. The OTC formulary and preferred drug lists can be viewed at www.indianapbm.com. Pharmacists and prescribing providers should contact the ACS Clinical Call Center with any questions concerning the PDL at (866) 879-0106.
Generic substitution in MDwise’s Care Select program is mandatory, as set out by state law (IC 16-42-22-10). Pharmacy providers must be fully aware of the provisions of the law and dispense accordingly. Pharmacy providers not dispensing with generic equivalent products when they exist are at risk for recoupment of the excess paid. Exceptions exist for "Brand Medically Necessary" circumstances and pharmacy providers should be fully aware of the provision in 405 IAC 5-24-8.
An in-house Pharmacy Services Helpdesk for Care Select providers is maintained by EDS and can be contacted by email at INXIXPharmacy@EDS.com, or by telephone at (317) 655-3240 (Indianapolis area) or (800) 655-3240, Monday through Friday, 8am-5pm, excluding state holidays. The helpdesk exists to answer provider questions related to processing of claims for pharmacy related services to Care Select members in the MDwise program and includes information on claims processing, billing and payment for pharmacy-related services, and member eligibility. Additional information can be found in the Pharmacy Services Section in the IHCP Provider Manual, Chapter 9.
A clinical call center is maintained by ACS and exists to answer provider questions regarding the pharmacy benefit or to process prior authorization requests for non-preferred drug products prescribed to Care Select members in the MDwise plan. The pharmacy benefit supports a preferred drug list consisting of drugs that have either preferred, or non-preferred status based on clinical and fiscal considerations. A complete and up-to-date copy of the preferred drug list for Care Select members in the MDwise plan is available at www.indianapbm.com. Typically, drug products that are non-preferred require a request for authorization to be completed by the prescriber and submitted to the ACS Clinical Call Center, by telephone at (866) 879-0106. Additional information can be found in the Pharmacy Services Section of the IHCP Provider Manual, Chapter 9. |
