Healthy Indiana Plan (HIP)
Pharmacy Services
Best Practices Generic Dispensing Rates
The MDwise pharmacy benefit for Healthy Indiana Plan is managed by the Office of Medicaid Policy and Planning (OMPP).
Information about the Healthy Indiana Plan pharmacy benefit can be found on the Indiana Health Coverage Programs' website, http://provider.indianamedicaid.com/provider-specific-information/pharmacy-services.aspx
and also at www.indianapbm.com.
This site contains important information about the pharmacy benefit program, including:
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Contact information
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Clinical edit and prior authorization criteria
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The Pharmacy Provider Manual and Forms
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Answers to frequently asked questions about the pharmacy benefit
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Information about Boards and Committees that oversee the pharmacy benefit
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Links to the Preferred Drug List (PDL) and the OTC Drug Formulary
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Search for IHCP Pharmacy Providers throughout the State
Questions?
For more information, call us today at 1.800.356.1204 or 317.630.2831 if you are in the Indianapolis area.
HIP "Buy-In Program" Pharmacy Benefits NEW!
MDwise members participating in the HIP Buy-In program have a different pharmacy benefit than MDwise members participating in the Traditional HIP program. Read more...
What's on the PDL?
Drugs in classes included on the PDL are shown as either "preferred" or "non-preferred."
In general, preferred drugs do not require prior authorization and non-preferred drugs do require prior authorization.
The PDL is not intended to show all drugs covered by the IHCP, Some drug classes are purposefully not shown on the PDL and most drugs in those classes are covered by the IHCP and do not require prior authorization.
Legend drug products that are listed as non-preferred in the IHCP PDL require prior authorization.
Providers are advised to refer to the IHCP PDL for the list of preferred pharmacy products or call the ACS Clinical Call Center at 1.866.879.0106.
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