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 IngenioRx to provide these pharmacy benefits.
Find A Pharmacy
Individuals who meet these eligibility factors can apply:Find a Pharmacy
Fill 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. 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
Prescription Drug Home Delivery Form
You can get many prescription drugs shipped directly to your home through IngenioRx Home Delivery. Use this form to set up home delivery on your prescription.
You can reach the Care Team at 1-833-255-0646 (TTY 711), 24 hours a day, seven days a week.
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
$4 per prescription
$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 drugs and a $10 copay for brand-name drugs.
Hoosier Care Connect Members
$3 copay per script
There is no pharmacy copay if you’re:
- Under 18 years old.
- American Indian or Alaskan Native.
- Receiving services related to pregnancy or family planning.
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.
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 firstname.lastname@example.org. You’ll be asked to supply a reason why it should be covered, such as an allergic reaction to a drug, etc.
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.
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.
Healthy Indiana Plan
Hoosier Care Connect
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 IngenioRx Specialty Pharmacy and other pharmacies to meet all your specialty medication needs. Learn about specialty pharmacy.
Page Last Updated: 10/28/2022