MDwise uses a company called MedImpact to provide quality and affordable prescription drug coverage for you and your family. This allows MDwise to get you the most from your Hoosier Healthwise (HHW) and Healthy Indiana Plan (HIP) benefits.
Together with MDwise, MedImpact manages the list of covered drugs called a Formulary. It is important you understand what drugs are covered on the formulary. Using the formulary will help you work with your doctors to get the most out of your benefits for you and your family.
You can obtain a copy of the formulary and learn how your drugs are covered by visiting MDwise.org/hip/pharmacy for HIP members and MDwise.org/mdwise/pharmacy-hoosier-healthwise for Hoosier Healthwise members. There you can use the Find a Drug tool to view information about the formulary. The Find a Drug Tool includes limits, quotas or other rules that may apply to medications on the formulary. Examples of these rules are explained in the table below. If needed, your doctor can provide information to support an exception request for any medication that doesn’t meet these rules or restrictions.
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Rule / Limit
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Description
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Quantity Limit
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This refers to a limit on the number of doses a patient can get in a given time frame (such as, you are allowed 30 tablets in 30 days).
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Step Therapy
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This refers to a rule where you must try certain products prior to getting other medications (for example, you must try “Drug A” before you can get “Drug B”).
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Age Restriction
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This refers to limits based on the patient’s age for a particular drug (for example, you can only get “Drug X” if you are 18 years of age or older).
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Prior Authorization
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This refers to medications that require your doctor to provide MDwise information to support the use of a particular medication (for example, before you can get Drug “Y,” your doctor will tell MDwise your diagnosis and any other treatments you may have tried for that diagnosis).
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Exception Request
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An exception request is when your doctor needs to ask MDwise to cover something that is normally not covered or exceeds usual rules/limits (for example, Drug “Z” is not covered due to one of the rules/limits, but your doctor believes we should consider covering it based on your specific health issues or concerns).
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A Formulary is sometimes also called a Preferred Drug List. MDwise follows the Indiana Health Coverage Programs (IHCP) Statewide Uniform Preferred Drug List (SUPDL). This means MDwise has the same set of formulary rules, coverages and limitations as the state’s Fee For Service (FFS) program. The state’s Fee For Service program is the Medicaid program managed directly by the state for members that are not enrolled in a managed care plan like MDwise. You can find information about the SUPDL by going to the Pharmacy Services page at in.gov/Medicaid/members or in.gov/medicaid/providers.
To learn what copayment, if any, applies to your medications, visit the MDwise website as listed below:
Hoosier Healthwise: https://www.mdwise.org/mdwise/benefits-and-services-hh
Healthy Indiana Plan: https://www.mdwise.org/mdwise/pharmacy-healthy-indiana-plan