MDwise works with a company called MedImpact to give you and your family low-cost and good quality drug coverage. This helps you get the most from your Hoosier Healthwise (HHW) and Healthy Indiana Plan (HIP) benefits.
MDwise and MedImpact manage a list of drugs that are covered. This list is called a formulary. It is important to know which drugs are on this list. The formulary helps you and your doctor choose the right medicine and make the most of your health benefits.
What is the Formulary?
A formulary is sometimes called a preferred drug list.
MDwise follows the Indiana Health Coverage Programs (IHCP) Statewide Uniform Preferred Drug List (SUPDL). This means MDwise uses the same drug rules, limits, and coverage as the state’s Fee-For-Service (FFS) Medicaid program. The FFS program is for people who are not in a managed care plan like MDwise.
To learn more about the SUPDL, go to https://inm.pharmacy.optum.com/inm/prelogin and select SUPDL under Quick Links.
How to Find the Formulary
You can see the formulary online:
There, you can use the Find a Drug tool. This tool tells you if your drug is covered. It also shows if there are limits or special rules for some drugs. These rules are explained in the chart below. If your drug has a rule, your doctor can ask for an exception by sending more information.
Drug Rules and What They Mean
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Rule / Limit
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What It Means
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Quantity Limit
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You can only get a certain amount of medicine in a set time. Example: 30 tablets in 30 days.
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Step Therapy
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You must try one drug before you can get a different one. Example: Try Drug A before Drug B.
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Age Restriction
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You must be a certain age to get the drug. Example: Only for people age 18 or older.
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Prior Authorization
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Your doctor must give MDwise more information before you can get the drug. Example: Tell MDwise your condition and what other treatments you have tried.
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Exception Request
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Your doctor asks MDwise to cover a drug that is not usually covered or goes over a limit. Example: Your doctor thinks you need Drug A even if a rule says no.
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Copay Information
To find out if you need to pay a copay for your medicine, visit the MDwise website: