Pharmacy and Prescription Drugs
Your Benefits Include A Wide Range Of Prescriptions And Over-The-Counter (OTC) Medicines
HIP Plus and Hoosier Care Connect members can even have their medicines delivered to their home. We work with CarelonRx to provide these pharmacy benefits.
Find A Pharmacy
Find a PharmacyFill A Prescription
Bring your member ID card and prescription to a plan pharmacy. Your doctor can also call in the prescription for you.
It’s good to use the same pharmacy each time you fill a prescription. This way, your pharmacist will know about problems that may happen when you’re taking more than one prescription. If you use another pharmacy, you should tell the pharmacist about all medicines you are taking.
Have Your Medicines Mailed To You
We make getting your prescriptions filled as convenient as possible. You can get many prescription drugs shipped directly to your home through CarelonRx Pharmacy. HIP Plus and Hoosier Care Connect members can log in to their account and manage prescriptions filled through home delivery. With a secure online account, you can:
- Order refills
- Track your shipments
- Get notifications
You can also reach the Care Team at 833-396-0309 (TTY 711), 24 hours a day, seven days a week.
Your Costs
Copays are a set dollar amount you pay for a covered service, like getting a prescription filled.
There is no pharmacy copay for:
- HIP Plus members.
- Women in the HIP Maternity Plan.
- American Indian/Alaska Native members.
- Members who have spent 5 percent of their income for copays and/or contributions.
- Drugs given as an emergency supply.
HIP Basic Members
Preferred Drugs
$4 per prescription
Nonpreferred drugs
$8 per prescription
Hoosier Healthwise Members
There is no pharmacy copay if you’re:
- In Package A (children and pregnant women).
- In Package P (women who are presumptively-eligible).
- Getting services in the ER, hospital or nursing home.
Hoosier Healthwise members who get benefits under Package C (children under 19 years of age who don’t qualify for Package A) have a $3 copay for generic, compound, sole source drugs, and multi-source brand drugs preferred on the SUPDL over available generics and a $10 copay for all other brand-name drugs.
Generic compound, sole source drugs, and multi-source brand drugs preferred on the SUPDL over available generics drugs
$3 copay
All other brand-name drugs
$10 copay
Hoosier Care Connect Members
There is no pharmacy copay.
Indiana PathWays for Aging Members
There is no pharmacy copay.
Drug Coverage Information
Your benefits include a wide range of prescription drugs. Anthem also covers many over-the-counter (OTC) medicines with a prescription from your doctor. We have two drug lists that show which drugs are in your plan.
Preferred Drug List (PDL)
The Preferred Drug List (PDL) has the medicines your plan pays for as long as you have a prescription. This includes over-the-counter (OTC) medicines. Your doctor doesn’t have to check with the plan before prescribing these for you. The PDL is updated frequently.
Searchable Formulary
The formulary is a list of all brand-name and generic drugs available in your plan. It lists all the drugs found on the PDL, plus others. All drugs on the formulary are covered, but many require preapproval before the prescription can be filled.
Find Your Medicine
Do you want to look up your medicine and find out if it is covered in your plan? It’s easy when you use our search tool. This tool will help you learn about any limitations or restrictions for any particular drug.
You can search for your drug by:
- Typing the name (at least first three letters) of the drug in the search box.
- Using the A-Z list to search by the first letter of your drug.
- Clicking on the therapeutic class of the drug.
Don’t See It Listed?
If you don’t see your medicine listed on the drug lists, you may ask for an exception at submitmyexceptionreq@anthem.com. You’ll be asked to supply a reason why it should be covered, such as an allergic reaction to a drug, etc.
Search Your Plan Formulary:
Prior Authorizations (Preapprovals)
Some medicines need a preapproval, or an “OK,” from Anthem before your provider can prescribe them. The preapproval process helps us make sure that you’re taking medications safely and correctly.
Here Are Some Reasons That Preapproval May Be Needed:
- There is a generic or pharmacy alternative drug available
- A drug is listed as nonpreferred on the PDL
- The drug could be misused or abused
- There are other drugs that should be tried first
- The drug has a high side effect potential
- You’re getting more drugs than what is normally expected
- The drug is prescribed at a higher dosage than recommended
- There is additional information needed about your condition so we can match it to the FDA approval of the drug and/or studies of effectiveness
For medicines that need preapproval, your provider will need to call Provider Services. Anthem will review the request and give a decision within 24 hours. If you need your medicine right away, you may be able to get a 72-hour supply while you wait.
Need Help?
If you misplace your medicine or it is stolen, contact your provider. They will work with the pharmacy and Anthem to review your case and replace the medicines as needed.
If you have any questions about your pharmacy benefit, call Pharmacy Member Services 24 hours a day, seven days a week.
Learn more about your pharmacy benefits in your member handbook.
Pharmacy Forms
Prescription Drug Reimbursement Form
If you had to pay for a medicine that is covered under your plan, you may submit a request for reimbursement form. You must have used an in-network plan pharmacy in order to be eligible for reimbursement.
Get Your Specialty Medications
If you have a complex or chronic health condition that requires special medicine, we can help. We partner with CarelonRx Specialty Pharmacy and other pharmacies to meet all your specialty medication needs. Learn about specialty pharmacy.
Page Last Updated: 7/5/2024