E-Prescribing, Formulary Searching and Exception Requests for MDwise Plans

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1 E-Prescribing, Formulary Searching and Exception Requests for MDwise Plans E-Prescribing Together with its pharmacy benefits managers (PBMs), MedImpact and PerformRx, MDwise provides physicians and other health care providers services to assist with the process of prescribing drug therapy for their patients. Prescribers have access to patient-specific prescription eligibility, medication history and basic formulary information for consenting patients in both inpatient and outpatient settings. This exchange of essential intelligence between prescribers and the MDwise PBMs enables physicians to write an informed prescription at the point of care. The MDwise PBMs interface with e-prescribing connectivity vendors to deliver these services to physicians who treat MDwise members. MDwise e-prescribing applications enable a prescriber to use a computer or hand-held device to: Electronically Access the Patient s Prescription Benefit o Electronically accessing a patient s prescription benefit, both formulary and eligibility, allows prescribers to choose medications that are on formulary and are covered by the patient's drug benefit. o Prescribers can also choose lower-cost alternatives such as generic drugs. o Dispensing pharmacies are less likely to receive prescriptions that require changes based on the patient's drug benefit, which, in turn, reduces unnecessary phone calls from pharmacy staff to physician practices regarding drug coverage. With the Patient s Consent, Electronically Access that Patient s Prescription History o Electronically accessing a patient's prescription history allows prescribers to receive important information on their patients' current and past prescriptions and to become better informed about potential medication issues with their patients (e.g., catching potentially harmful drug-to-drug and drug-allergy interactions). o Prescribers can also gain insight into a patient's medication adherence by understanding the dispensing cycle of a prescription. Electronically Route the Prescription to the Patient's Choice of Pharmacy o Exchanging prescription information electronically between prescribers and pharmacies improves the accuracy of the prescribing process o E-prescribing also saves time, primarily as the result of reduced pharmacy phone calls and faxes related to prescription renewal authorizations as well as from a reduced need for pharmacy staff to key in prescription data. 1

2 Online Formulary Search MDwise formularies may be accessed online by visiting MDwise.org. From the MDwise home page, click on the For Providers link on the horizontal bar across the top of the page. Next, select one of the quick links along the right side of the page: o Formulary for MDwise Marketplace o Formulary for Hoosier Care Connect o Formularies for HIP Plans 2

3 3 If you select the quick link for the HIP plans formularies, you will be taken to the Pharmacy Resources for HIP page. You can then select the Find a drug link for HIP Plus members, HIP Basic members or HIP State Plan members. The printable formularies are also available as a PDF under the Pharmacy Documents section.

4 If you are searching a formulary for Healthy Indiana Plan or Hoosier Care Connect: You may search the applicable MDwise formulary by typing the drug name in the search box. Once the search has been executed, all available strengths in both brand and generic (if available) will be listed. 4

5 By clicking on an individual medication from the options listed as described above, additional details will be provided such as the therapeutic class, the formulary tier and patient cost depending upon service location. By clicking on Restriction in the Your Cost column, any restrictions applicable to that medication (e.g., prior authorization, quantity limit, step therapy) will be displayed. 5

6 Further, therapeutic alternatives may be viewed by clicking on View Most Commonly Dispensed Similar Drugs. Once the alternatives are displayed, click on Find Price to determine the price of the drugs listed. 6

7 If you are searching the MDwise Marketplace formulary: You may search the MDwise Marketplace formulary by typing the drug name in the search box or by selecting one of the therapeutic classes listed below the search box. Once you have entered the drug name you will see a list of the available strengths for that drug as well as an indicator of which tier the drug is listed: 7

8 Click on the drug name and strength and you can see if a drug requires prior authorization, step therapy or has age, gender or quantity limits. Click on the icons to see more details about the requirement. If you wish to search therapeutic alternatives that may be in other tiers or which may not require prior authorization or step therapy, click on the therapeutic class name. If you have questions about using this website or these tools, please call the MDwise customer service number for the appropriate plan: MDwise Health Indiana Plans and Hoosier Care Connect: MDwise Marketplace: Exception Requests (Prior Authorization) Members and prescribers have the right to request a timely review for coverage of a non-formulary pharmaceutical based on medical necessity as determined by the member's clinical needs. This exception request may occur before coverage is denied and can possibly resolve the request before it may become a formal appeal. Healthy Indiana Plan and Hoosier Care Connect Prescribers have the option of calling MedImpact directly to submit exception or prior authorization (PA) requests. MedImpact operates a dedicated telephone queue for intake of PA requests. PA staff is available on a toll free phone line ( ) for PA case intake and inquiries from 9:00 a.m. through 9:00 p.m. Eastern Time, Monday through Friday. Requests and supporting information may also be sent by fax to the MedImpact PA department at This line operates 24 hours per day, seven days per week, 365 days per year. In addition contact center staff is available on a toll-free phone line ( ) 24 hours per day, seven days per week and 365 days per year to answer questions about the status of a request. 8

9 MDwise Marketplace Requests for exceptions for MDwise Marketplace members are handled in the same manner as Healthy Indiana Plan and Hoosier Care Connect, but those requests and supporting documents should be sent to PerformRx. To request prior authorization over the phone, please call To request standard prior authorization via fax, please fax the appropriate documents to For urgent prior authorization requests, please fax the appropriate documents to