important information

Medicaid eligibility review is underway for many MDwise members. Encourage patients to update their info with FSSA so they don’t lose their health coverage!

Info for patients

Pharmacy Resources

Statewide Uniform Preferred Drug List (SUPDL)

Effective July 5, 2023, all managed care plans will align with the fee for service (FFS) program under the Statewide Uniform Preferred Drug List (SUPDL). This means that MDwise will cover the same preferred and nonpreferred drugs and maintain the same clinical criteria requirements as other Indiana Medicaid providers.

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

hoosier healthwise insurance logo

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)

healthy indiana plan logo

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?

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 various HIP plans.

Pharmacy Documents and Links

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

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