What kinds of Pharmacy Services are offered?
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?
Are over-the-counter (OTC) drugs covered?
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?
What is a specialty drug?
Can I get a 90 day supply of medications? (Available through mail-order)
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