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.
Log in to your member portal and view your specific pharmacy benefit information including claims history, pharmacy locations, and list of prescriptions you have filled.
All MHS members must use a pharmacy in the Indiana Medicaid network, including mail-order pharmacies.
You can find an in-network pharmacy by using the Find a Provider tool.
To find an in-network pharmacy:
- Go to mhsindiana.com and click on Find a Provider.
- Click Start Your Search. A new window will open.
- Enter your zip code, and choose Hoosier Healthwise as your plan
- Click Detailed Search
- In the Type of Provider box, choose Pharmacy
- 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.
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.
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.
The Hoosier Healthwise PDL provides 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.
Search within the PDL by pressing Control + F
Hoosier Healthwise members can get a 90 day (3 months) supply of maintenance medications (PDF) from our preferred mail order pharmacy CVS Caremark. Maintenance medications are medications used to treat long-term chronic conditions or illnesses. Caremark may be reached at 1-888-624-1139 or visit Caremark's Prescription Delivery page.
Your pharmacist will give you generic drugs when your doctor has approved them. Generic drugs are the same as brand-name drugs and make healthcare more affordable. 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.
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 – Provides a short list of OTC drugs for the treatment of some illnesses. Most of these OTC drugs are generic.
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” next to the specialty drug name.
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 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 Forms.