Pharmacy Benefits

When you need either prescription or over-the-counter (OTC) drugs, your doctor will write you a prescription. Your doctor will then contact your pharmacy, or you can take the prescription to your pharmacy to fill the order and get your drug(s).
MHS is committed to providing appropriate, high-quality, and cost-effective drug therapy to all MHS members. MHS works with providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered.

Secure Pharmacy Member Portal
Log in to your secure pharmacy member portal at usscript.com and view your specific pharmacy benefit information including drug copays, pharmacy locations, and list of prescriptions you have filled.

Find a Pharmacy
All MHS members must use a pharmacy in the Indiana Medicaid network, including mail-order pharmacies.

Healthy Indiana Plan, Hoosier Healthwise and Hoosier Care Connect:

You can find an in-network pharmacy by using the Find a Provider tool at mhsindiana.com

To find an in-network pharmacy:

  1. Go to mhsindiana.com and click on Find a Provider.
  2. Click Start Your Search. A new window will open.
  3. Enter your zip code, and choose your plan.
  4. Click Detailed Search.
  5. In the Type of Provider box, choose Pharmacy.
  6. Click Search

Always present your member ID card to the pharmacy every time you fill or pick up an order. Do not wait until you are out of a drug to request a refill. Please call your doctor or pharmacy a few days before you run out.

Covered Prescriptions
MHS covers prescription medications and certain over-the-counter (OTC) medications when ordered by an Indiana Medicaid enrolled MHS practitioner. For example:

  • Prescription drugs and OTC items approved by the U.S. Food and Drug Administration (FDA). See the following sections labeled “Preferred Drug List” and “Over the Counter Drug List” for more information.
  • Self-injectable drugs (including insulin).
  • Drugs to help you quit smoking.

You will also be able to get needles, syringes, blood glucose monitors, test strips, lancets and glucose urine testing strips at your pharmacy.

The pharmacy program does not cover all medications. Some medications require prior authorization (PA) or have limitations on age, dosage, and maximum quantities.

Preferred Drug Lists (PDL) / Formulary

Your pharmacy benefit has a Preferred Drug List (PDL). The PDL applies to drugs you receive at retail pharmacies. These are drugs we prefer that your provider prescribes. A team of doctors and pharmacists updates this list four times a year. Updating this list ensures the drugs are safe and useful for you and cost-effective for the Indiana Medicaid program. You can find your plan’s PDL here:

The Hoosier Care Connect, HIP Basic and Hoosier Healthwise PDLs provide a broad selection of drugs for the treatment of most illnesses. This list includes mostly generic drugs along with a limited number of brand-name drugs. Some drugs will only be covered with a prior authorization.

The HIP Plus PDL provides an expanded selection of drugs for the treatment of most illnesses. This list includes many generic drugs along with a larger list of brand-name drugs. If you have the HIP Plus plan, you will not have to pay a copayment for your drugs. More brand-name drugs are available on the HIP Plus PDL without the need for a prior authorization.

Maintenance Drug List
MHS offers a 90 day (3 months) supply of maintenance medications by mail-order. Maintenance medications are medications that are used to treat long-term conditions or illnesses. You can transfer a current prescription, and/or have your doctor phone prescriptions directly to HomeScripts at 1-800-785-4197, or visit homescripts.com. Contact an MHS Member Services representative if you have any questions about this program.

 

Over-the-Counter (OTC) Drug Formulary

Some OTC drugs are covered by Indiana Medicaid. Even listed OTC drugs require a doctor’s prescription to be covered. You can find the OTC Drug Formulary within each PDL option listed above on this page.

  • Hoosier Healthwise, Hoosier Care Connect, HIP State Plan and HIP Basic – Provides a short list of OTC drugs for the treatment of some illnesses. Most of these OTC drugs are generic.
  • HIP Plus – The HIP Plus PDL provides a larger list of OTC drugs for the treatment of some illnesses. There is no copay for the medications.

Prior Authorizations for Drugs

Some drugs may need prior authorization from MHS. If you need a drug that requires prior authorization, you or your doctor will need to provide information about your health in order for a decision to be made about whether or not Hoosier Healthwise or MHS can pay for the drug. MHS covers some drugs injected in a doctor’s office or clinic and some medications taken by mouth that are classified as specialty drugs. These drugs must be approved through MHS before MHS will cover them. The list of specialty drugs is available on our website. You or your doctor must send a request for prior authorization if:

  • A drug is listed as non-preferred on the PDL or if certain conditions need to be met prior to you receiving the drug.
  • You are getting more of the drug than is usually prescribed.
  • There are other drugs that are recommended to be tried first.

In most cases, you may get up to a three-day (72 hour) supply of a drug that requires prior authorization while you are waiting for a decision. The decision will be made within one day (24 hours), and you and your doctor will be notified of the decision.

You or your prescriber can download copies of our prior authorization forms (including specialty forms) from our Provider Information Resource Center.