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Pharmacy Benefits

Indiana Health Coverage Programs (IHCP) pharmacy benefits are administered as follows:

  • OptumRx is the Pharmacy Benefit Manager (PBM) and pharmacy claims processor for members enrolled in programs and benefit plans administered under the IHCP fee-for-service (FFS) delivery system.
  • The individual managed care entities (MCEs) serving Healthy Indiana Plan (HIP), Hoosier Care Connect, and Hoosier Healthwise members, administer the pharmacy benefits and claims processing for their enrolled members under the IHCP managed care delivery system.

Providers can find hyperlinks to pharmacy benefit information, including preferred drug lists (PDLs) and drug prior authorization (PA) criteria, on the Pharmacy Services page of this website. Select the hyperlink associated with the program/health plan with which the member is enrolled to see applicable pharmacy benefit information.

Other pharmacy services information is also available at these websites, including information about:

  • Drug Utilization Review (DUR) Board
  • Mental Health Quality Advisory Committee (MHQAC)
  • Preferred Diabetic Supply List (PDSL)
  • Medicare prescription drug coverage
  • Therapeutics Committee (OptumRx)
  • State Maximum Allowable Cost (SMAC) program (OptumRx)

The Pharmacy Services provider reference module, accessible from the Provider Reference Materials page on this website, outlines pharmacy policies and procedures.

You can find other FFS pharmacy contact information, including contacts for pharmacy prior authorization and pharmacy claims, on the IHCP Quick Reference Guide.

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