Prior Authorization

This means that you will need to get approval from IU Health Plans (HMO) (HMOPOS) before you fill your prescriptions for some drugs. If you don't get approval, IU Health Plans (HMO) (HMOPOS) may not cover the drug. You can find out which drugs require prior authorization by reviewing the IU Health Plans (HMO) (HMOPOS) Formulary. Usually, your physician or other prescribers will have to give us information about your medical condition or previous prescriptions in order to receive prior authorization.

Generally, we must make our decision within 72 hours of getting you or your physician’s or other prescribers' request for standard coverage determinations or 24 hours of getting you or your prescribing physician's request for an expedited coverage determination.

• Click here for the IU Health Plans (HMO) (HMOPOS) Drug Formulary

Members who would like to request a prior authorization or check on the status of a prior authorization request submitted by their physician or other prescriber should contact our Member Services Department 8:00 a.m. to 8:00 p.m., seven days a week:

• Click here to download the Enrollees Coverage Determination Request Form. Mail or fax the completed form to:

IU Health Plans (HMO) (HMOPOS)
Prior Authorization Department
200 Stevens Drive
Philadelphia, PA 19113

• Click here for the Appointment of Representative Form and for more information on how to appoint a representative.

Physicians and other prescribers who would like to submit a prior authorization request may either contact our Provider Help Desk at 1-866-907-7088, or use our physician's coverage determination form available below. Please answer all questions on the form and fax to the phone number listed on the form.

• Click here for the Physician's Coverage Determination Request Form. Fax or mail the completed form to:

IU Health Plans (HMO) (HMOPOS)
Prior Authorization Department
200 Stevens Drive
Philadelphia, PA 19113

What can I do if my Coverage Determination is denied?
If IU Health Plans (HMO) (HMOPOS) denies your coverage determination you have the right to request a redetermination appeal. Please see our section on Appeals and Grievances for information about your appeal rights, or contact our Member Appeals Department 8:00 a.m. - 8:00 p.m., seven days a week.

• Click here for more information on Appeals & Grievances.
• Click here for the Redetermination Request Form