2018 Searchable Formulary
You may search our prescription drug formulary in several ways:
- You can use the alphabetical list to search by the first letter of your medication.
- You can search by typing part of the generic (chemical) or brand (trade) names.
- You can search by selecting the therapeutic class of the medication you are looking for.
How do I request an exception to the formulary? To submit a request for a coverage determination, utilization exception, formulary exception, or tiering exception:
- Request Form – Coverage Determination, Formulary Exception or Tiering Exception: Medicare Part D enrollees can use this form to request coverage determinations (including tiering, utilization or formulary exception requests) from their Medicare Part D plan sponsor. You or your physician can request a prescription coverage determination or an appeal by calling 866.823.1016 (TTY users should dial 800.743.3333 for Indiana Relay). For more information on how to submit a request for an exception to the formulary, please click here.
Download A Printable Formulary
Please use the link below to download our drug formulary.
A prescription drug formulary is a list of drugs a Medicare Advantage plan covers. The IU Health Plans (HMO) (HMOPOS) formulary includes thousands of brand-name and generic medications. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs. These drugs have been approved for coverage by the health plan and are also reviewed and approved by the Centers for Medicare and Medicaid Services (CMS), the agency that administers the Medicare Program.
Some of the drugs that IU Health Plans (HMO) (HMOPOS) cover may require you to obtain prior approval. Click on the link below to view any drugs that require prior authorization:
Click the link below to see a list of drugs that require step therapy:
For certain prescription drugs, IU Health Plans (HMO) (HMOPOS) has additional requirements for coverage or limits on coverage. These requirements and limits ensure that members use these drugs in the most effective way and to control drug costs. A team of doctors and pharmacists developed these requirements and limits. Examples of utilization management tools are described below:
- Prior Authorization IU Health Plans (HMO) (HMOPOS) requires you to get prior authorization for certain drugs. This means that approval is required prior to coverage. If you do not get approval, we may not cover the drug.
- Quantity Limits For certain drugs, IU Health Plans (HMO) (HMOPOS) limits the amount of the drug that we will cover per prescription or for a defined period of time.
- Step Therapy In some cases, we require you to first try one drug to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both effectively treat a medical condition, we may require your doctor to prescribe Drug A first. If Drug A does not work for you, then we will cover Drug B.
- Generic Substitution When there is a generic version of a brand-name drug available, network pharmacies will automatically give you the generic version, unless your doctor has told IU Health Plans (HMO) (HMOPOS) that you must take the brand-name drug and have obtained a prior authorization.
You can find out if the drug you take is subject to these additional requirements or limits by looking in the Formulary. If your drug is subject to one of these additional restrictions or limits and your physician determines that you aren’t able to meet the additional restriction or limit for medical necessity reasons, you or your physician may request an exception (which is a type of coverage determination).
Drug Utilization Review
We conduct drug utilization reviews for our members to make sure that they are getting safe and appropriate medications. These reviews are especially important for members who go to more than one doctor and/or pharmacy for their medications. We conduct drug utilization reviews each time you fill a prescription and on a regular basis by reviewing our records. During these reviews, we look for medication problems such as:
- Possible medication errors
- Duplicate drugs that are unnecessary because you are taking another drug to treat the same medical condition
- Drugs that are potentially inappropriate because of the member’s age or gender
- Possible harmful interactions between drugs you are taking
- Drug allergies
- Drug dosage errors
If we identify a medication problem during our drug utilization review, we will work with you and your doctor to correct the problem