Pharmacy
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.
Fill a Prescription
Bring your member ID card and prescription to a plan pharmacy. A 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. Anthem 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
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
Drug Coverage Information
Your benefits include a wide range of prescription drugs. The Anthem HealthKeepers Plus plan 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. Oftentimes, your doctor doesn’t have to check with the plan before prescribing these for you. The PDL is updated frequently.
Hoosier Healthwise PDL – English
Hoosier Healthwise PDL – Spanish
Hoosier Care Connect PDL – English
Hoosier Care Connect PDL – Spanish
Indiana PathWays for Aging - English
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 to Z list to search by the first letter of your drug.
- Clicking on the therapeutic class of the drug.
Search your plan formulary:
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.
Prior authorizations
Some medicines need a prior authorization, or an “OK,” from Anthem before your provider can prescribe them. The prior authorization process helps us make sure that you’re taking medications safely and correctly.
Here are some reasons that prior authorizations 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 prior authorization, your provider will need to call Provider Services or submit a request online. 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.
Healthy Indiana Plan
833-205-6007 (TTY 711)
Hoosier Healthwise
833-235-2023 (TTY 711)
Hoosier Care Connect
833-235-2024 (TTY 711)
Indiana PathWays for Aging
833-412-4405 (TTY 711)
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.
CarelonRx Reimbursement Form – English
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.
Page last update: 12/10/2024