Pharmacy Resources

Statewide Uniform Preferred Drug List (SUPDL)

All managed care plans are aligned with the fee for service (FFS) program under the Statewide Uniform Preferred Drug List (SUPDL). This means that MDwise covers the same preferred and nonpreferred drugs and maintains the same clinical criteria requirements as other Indiana Medicaid providers.

The SUPDL may be viewed on the FFS website:
https://inm-providerportal.optum.com/providerportal/faces/PreLogin.jsp.
From the homepage, click Preferred Drug List on the right.
Prior authorization criteria for drugs on the SUPDL may be viewed on the FFS website:
https://inm-providerportal.optum.com/providerportal/faces/PreLogin.jsp.
From the homepage, click PA Criteria and Administrative Forms on the right. Under the heading Pharmacy Forms, click on Pharmacy Prior Authorization Criteria and Forms.
Ongoing updates to the SUPDL occur after approval by the Indiana Medicaid Drug Utilization Review (DUR) Board. Monthly IHCP Bulletins report the DUR Board decisions and may be viewed here: Indiana Medicaid: Providers: Reference Search Results
PA forms for drugs on the SUPDL should be accessed from the list below. Please DO NOT utilize FFS PA forms for MDwise enrollees.

SUPDL Prior Authorization Forms

MDwise Neutral Agents Prior Authorization Criteria

SUPDL implementation will not affect products in drug classes not listed on the FFS PDL. Agents in drug classes not included on the FFS PDL are considered neutral, meaning they have not been assigned a preference status. MDwise will continue to use its own clinical criteria and coverage policies for these neutral agents.

Prior authorization criteria for neutral drugs may be viewed on the MDwise website.

Pharmacy benefits are managed through MedImpact. Please select the program listed below for more information on pharmacy resources.

Hoosier Healthwise Plan

Healthy Indiana Plan

Hoosier Healthwise

A health plan for children under the age of 19 and pregnant women.

MedImpact is the pharmacy benefit manager (PBM) and pharmacy claims processor for MDwise Hoosier Healthwise program.

MedImpact is responsible for:

Processing pharmacy and compound claims.
Maintaining the formulary
Processing prior authorization requests
Auditing Pharmacy providers
Managing Specialty pharmacy claims

Questions Concerning Prior Authorizations?

Pharmacists and prescribing providers should contact MedImpact with any questions concerning prior authorizations at 1-800-788-2949. Providers can fax the completed Medication Request Form to 858-790-7100. View the forms.

Formulary and Pharmacy Search

A searchable formulary and participating pharmacies are available by selecting the links below for the MDwise Hoosier Healthwise plan.

Find a pharmacy for HHW members
Find a drug for HHW members

Healthy Indiana Plan (HIP)

A health plan for adults age 19 - 64.

MedImpact is the pharmacy benefit manager (PBM) and pharmacy claims processor for the MDwise Healthy Indiana Plan program.

MedImpact is responsible for:

Processing pharmacy and compound claims.
Maintaining the formulary.
Processing prior authorization requests.
Auditing pharmacy providers.
Managing specialty pharmacy claims.

Questions Concerning Prior Authorizations?

Formulary and Pharmacy Search

A searchable formulary and participating pharmacies are available by selecting the links below for the various HIP plans.

Pharmacy Documents and Links

The machine-readable file format is in accordance with CMS regulations and guidance.