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Pharmacy Information

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Effective January 1, 2010, the state of Indiana will administer pharmacy benefits for the Hoosier Healthwise and Healthy Indiana Plan. For more information go to www.indianamedicaid.com and select the tab Pharmacy Services. 
Facts about Generic Drugs
 
Preferred Drug List
The Preferred Drug List (PDL) is located on the state’s website at www.indianamedicaid.com and here
 
Prior Authorization (PA) Process
All prior authorization forms for pharmacy can be found on the state’s website at http://provider.indianamedicaid.com/general-provider-services/providing-services/prior-authorization.aspx, under the section titled Pharmacy Forms. 
Preferred Drug List for Buy-In Level One Healthy Indiana Plan Members
For providers seeing HIP members who are a part of the Buy-In Level One Membership (member ID cards will not have a RID number for submitting claims to Anthem for items on this formulary). You will find prior authorization forms for pharmacy services here.
Pharmacy Prior Authorization Form
 
 
Benefit Exclusions
Benefit exclusions are those services that are not covered under the pharmacy benefit which include the following medications:  

Infertility medications

Cosmetic and hair medications

Erectile dysfunction medications

Drugs not approved by FDA

 
Last Update: 12/31/09 Version: 6  
 
©2005-2014 copyright of Anthem Insurance Companies, Inc.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use