Pharmacy Pill bottles

Indiana Pharmacy Benefits

OptumRx is the Pharmacy Benefit Manager (PBM) and fee-for-service (FFS) pharmacy claims processor for the Indiana Health Coverage Programs (IHCP). For information related to the IHCP pharmacy program, see the following resources:

  • The Pharmacy Services quick link at this website - Use this quick link to access information on topics including:
    • Therapeutics Committee
    • Drug Utilization Review (DUR) Board
    • Mental Health Quality Advisory Committee (MHQAC)
    • Preferred Drug List (PDL) and Over-the-Counter (OTC) Drug Formulary
    • Preferred Diabetic Supply List (PDSL)
    • State Maximum Allowable Cost (SMAC) program
    • Medicare prescription drug coverage
  • The Pharmacy Services provider reference module ‒ This 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.

Managed Care Pharmacy Benefits

The individual managed care plans serving Healthy Indiana Plan (HIP) and Hoosier Care Connect administer the pharmacy benefits and claims processing for their enrolled members. Please see the Managed Care Pharmacy Benefits page on this website for more information.

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