Pharmacy FAQs

What kinds of Pharmacy Services are offered?

MHS covers certain prescription drugs and over-the-counter drugs when written on a prescription, by a practitioner in the MHS provider network. The pharmacy program does not cover all drugs. Some require prior authorization. Some drugs have limitations on age, dosage, or maximum quantities.

What is the Preferred Drug List?

The Preferred Drug List (PDL) is the list of drugs covered by MHS. The PDL applies to drugs that members receive at retail pharmacies. The MHS Pharmacy and Therapeutics Committee checks the PDL quarterly to make sure the list includes medicines that are right for our members, as well as cost-effective. The Committee is composed of the MHS Medical Director, MHS Pharmacy Director, and several Indiana physicians, pharmacists, and specialists.These prescriptions drugs are not covered:

  • Over-the-counter (OTC) medicines (unless specified on the formulary or PDL list)
  • Drugs used to get pregnant
  • Experimental or investigational drugs
  • Drugs for cosmetic reasons
  • Drugs for weight loss
  • Drugs for hair growth
  • Drugs to treat erectile dysfunction

What about generic drugs?

Your pharmacist will give you generic drugs when your doctor has approved them. All generic drugs approved by FDA have the same high quality, strength, purity, and stability as brand-name drugs. If generics are not available, you may be given brand-name drugs. Generic and preferred drugs must be used when available for your medical condition unless your doctor provides a medical reason you must use a different drug.

Are over-the-counter (OTC) drugs covered?

Some OTC drugs are covered by your PDL. Only OTC drugs that are listed on your PDL may be covered. OTC medications are only covered when written by your physician on a prescription.

What is a prior authorization?

Some medications listed on the PDL may require a prior authorization. The prior authorization request should be submitted by the doctor or pharmacist on the Medication Prior Authorization Form. Directions on how to submit are included on this form. You can find a copy of the Medication Prior Authorization Form on the Provider Forms page.

MHS will cover medication if it is determined that:

  • There is a medical reason the member needs the specific medication.
  • Depending on the medication, other medications on the PDL have not worked.

How do I know which pharmacy to use?

You must use a pharmacy in the MHS network. To find the pharmacy closest to you, use the Find a Provider search at usscript.com. Click on “Pharmacy Locator” and then choose “Search” after entering your address or zip code. Or, call US Script, toll-free at 1-800-460-8988.

What is a specialty drug?

Specialty drugs are drugs that are usually used to treat complex medical conditions and have unique storage and handling instructions. Often these medications are injectable and high cost. These medications have to be filled at our preferred specialty pharmacy. These drugs are marked on the PDL with the letter “S”. Or, for a comprehensive list of specialty drugs, view the Specialty Drug List.

Can I get a 90 day supply of medications? (Available through mail-order)

HIP Plus, Hoosier Healthwise and Hoosier Care Connect members can get a 90 day (3 months) supply of maintenance medications from our preferred mail order pharmacy Home Scripts. Maintenance medications are medications used to treat long-term chronic conditions or illnesses. Home Scripts may be reached at 1-800-785-4197 or online at usscript.com/homescripts.

Is there a copayment for drugs?

  • HIP members in the Basic and State Basic plans will need to pay $4 for preferred drugs and $8 for non-preferred drugs unless you have an excluded condition.
  • HIP members in the Plus or State Plus plans do not pay copays for prescriptions.
  • Hoosier Healthwise members will need to pay a $3 copay for generic and $10 copay for brand drugs unless you have an excluded condition.
  • Hoosier Care Connect members will need to pay a $3 copay for each prescription unless you have an excluded condition.
  • Excluded conditions include members who are pregnant, of Native American descent, less than 18 years of age or have already met their 5% cost sharing max.
  • Medications for family planning will be exempt from copays