Member Eligibility & Benefits

Pharmacy Information

Anthem Blue Cross and Blue Shield will administer pharmacy benefits for members enrolled in Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect. IngenioRx is the pharmacy benefits manager. Please refer to the preferred drug list (PDL) when prescribing for these members.

Specialty Drug List
Benefit Exclusions

Benefit exclusions are services not covered under the pharmacy benefit, which include medications:

  • To treat infertility
  • To treat erectile dysfunction
  • For cosmetic reasons (Anti-wrinkle, hair removal, hair growth)
  • Not approved by the FDA
  • That can be bought over-the-counter (unless specified on formulary or PDL)

Page Last Updated: 10/01/19

To get pharmacy prior authorizations:

Log In to Availity

or

You can also request prior authorization by calling:

  • 1-866-408-6132 (Hoosier Healthwise)
  • 1-844-533-1995 (Healthy Indiana Plan)
  • 1-844-284-1798 (Hoosier Care Connect)

Fax

  • 1-844-864-7860 (Retail)
  • 1-888-209-7838 (MI)

To find an in-network pharmacy,

use our Find a Doctor tool. All questions related to payments and statements made prior to October 1, 2019, should be faxed to 1-877-892-2692. For inquiries beginning October 1, 2019, Chain and Pharmacy Services Administration Organization (PSAO) pharmacies can submit paid claim appeals through their respective chain or PSAO headquarters, which will then submit appropriate data to Caremark. Independent pharmacies (those that are not affiliated with a PSAO for contracting purposes) can submit paid claim appeals using the Caremark Pharmacy Portal at https://rxservices.cvscaremark.com.