A formulary is a list of drugs that a plan covers. IU Health Plans (HMO) (HMOPOS) will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your IU Health Plans (HMO) (HMOPOS) Evidence of Coverage.
The formulary has been reviewed and approved by the Centers for Medicare and Medicaid Services (CMS), the agency that administers the Medicare Program. Formulary medications are FDA-approved and have been chosen for their reported medical effectiveness and value. Formularies are reviewed periodically to add new drugs and to remove brand-name drugs when a generic equivalent becomes available.
IU Health Plans covers both brand name drugs and generic drugs. 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.
What if my drug is not on the Formulary?
First, contact Member Services and ask if your drug is covered. If Member Services says that IU Health Plans (HMO) (HMOPOS) does not cover your drug, you have 2 options:
- You can ask Member Services for a list of similar drugs that are covered by IU Health Plans. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by IU Health Plans (HMO) (HMOPOS).
- You can ask IU Health Plans (HMO) (HMOPOS) to make an exception and cover your drug.
For more information, contact IU Health Plans (HMO) (HMOPOS) Member Appeals Department 8:00 a.m. to 8:00 p.m., 7 days a week.
||IU Health Plans (HMO) (HMOPOS) Appeals & Grievances