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 prescriptions, please review the 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 (HMO) (HMOPOS) 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.
Find a Formulary Drug
What if the drug I prescribed is not on the Formulary?
First, contact the Provider Help Desk and ask if the drug is covered. If IU Health Plans (HMO) (HMOPOS) does not cover the drug, you have 2 options:
- You can review the Formulary and prescribe a similar drug that is covered by IU Health Plans.
- You can ask IU Health Plans (HMO) (HMOPOS) to make an exception and cover the drug. Click here to find out about coverage determination, exceptions, and appeals.
For more information, contact the Provider Help Desk at 1-866-907-7088.