Coronavirus (COVID-19) updates and free virtual screenings info

Learn more about COVID-19
Get the latest resources and information about COVID-19. Get answers to frequently asked questions, information about free COVID-19 virtual screenings for Indiana residents and list of symptoms.

View Details on Free Virtual Screening with IU Health
IU Health has a free virtual clinic to offer individuals in Indiana free Coronavirus (COVID-19) screenings using the IU Health Virtual Visit app. 

Connect with our Customer Solutions team
At IU Health Plans, we’re available to address all of your questions in a timely and efficient manner. Our Customer Solutions team is here to assist with any questions regarding your IU Health Plan benefits during this time.

Refill of a Prescription Medication
IU Health Plans has taken steps to design the best care for you during this COVID-19 outbreak. You may now take advantage of: 

- Relaxed refill restrictions. For our Commercial and Medicare customers, IU Health Plans is waiving early refill limits on up to three, 30-day prescription supplies for maintenance medications at any in-network pharmacy, in all states. This change applies to maintenance medications only. 30-day overrides are not available for specialty medications or controlled substances. 

- Free home delivery. Participating CVS Pharmacies in our network have waived charges for home delivery of all prescription medications. The Centers for Disease Control and Prevention (CDC) encourages people at higher risk for COVID-19 complications to stay at home as much as possible, so this convenient option can help you avoid leaving your home for refills or new maintenance prescriptions. As always, there is no charge for delivery of prescriptions filled by the CVS Caremark Mail Service pharmacy, when you choose the mail order service.

CVS Caremark mail order form
Contact your doctor’s office for a prescription. If you need your prescription filled anytime within the next week, you will need to ask your doctor to write two prescriptions for your long-term medicines, one that you can fill immediately at a participating pharmacy, and the second for the mail order to be mailed to CVS Caremark.

Mail the order form, along with your prescription(s) to be shipped by mail. Include your payment to the CVS Caremark Mail Service Pharmacy address printed on the form. You will be required to make your prescription drug payments using an electronic check, Bill Me Later®, or a credit card (VISA®, MasterCard®, Discover® or American Express®). You can also pay by check or money order. You should not send cash.

Coronavirus (COVID-19) updates and free virtual screenings info

Learn more about COVID-19
Get the latest resources and information about COVID-19. Get answers to frequently asked questions, information about free COVID-19 virtual screenings for Indiana residents and list of symptoms.

View Details on Free Virtual Screening with IU Health
IU Health has a free virtual clinic to offer individuals in Indiana free Coronavirus (COVID-19) screenings using the IU Health Virtual Visit app. 

Connect with our Customer Solutions team
At IU Health Plans, we’re available to address all of your questions in a timely and efficient manner. Our Customer Solutions team is here to assist with any questions regarding your IU Health Plan benefits during this time.

Refill of a Prescription Medication
IU Health Plans has taken steps to design the best care for you during this COVID-19 outbreak. You may now take advantage of: 

- Relaxed refill restrictions. For our Commercial and Medicare customers, IU Health Plans is waiving early refill limits on up to three, 30-day prescription supplies for maintenance medications at any in-network pharmacy, in all states. This change applies to maintenance medications only. 30-day overrides are not available for specialty medications or controlled substances. 

- Free home delivery. Participating CVS Pharmacies in our network have waived charges for home delivery of all prescription medications. The Centers for Disease Control and Prevention (CDC) encourages people at higher risk for COVID-19 complications to stay at home as much as possible, so this convenient option can help you avoid leaving your home for refills or new maintenance prescriptions. As always, there is no charge for delivery of prescriptions filled by the CVS Caremark Mail Service pharmacy, when you choose the mail order service.

CVS Caremark mail order form
Contact your doctor’s office for a prescription. If you need your prescription filled anytime within the next week, you will need to ask your doctor to write two prescriptions for your long-term medicines, one that you can fill immediately at a participating pharmacy, and the second for the mail order to be mailed to CVS Caremark.

Mail the order form, along with your prescription(s) to be shipped by mail. Include your payment to the CVS Caremark Mail Service Pharmacy address printed on the form. You will be required to make your prescription drug payments using an electronic check, Bill Me Later®, or a credit card (VISA®, MasterCard®, Discover® or American Express®). You can also pay by check or money order. You should not send cash.

Search

Formulary Resources

A prescription drug formulary is a list of drugs a Medicare Advantage plan covers. The IU Health Plans (HMO) (HMOPOS) formulary includes thousands of brand-name and generic medications. 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. These drugs have been approved for coverage by the health plan and are also reviewed and approved by the Centers for Medicare and Medicaid Services (CMS), the agency that administers the Medicare Program. Some of the drugs that IU Health Plans (HMO) (HMOPOS) cover may require you to obtain prior approval.

Click on the link below to view any drugs that require prior authorization:

Click the link below to see a list of drugs that require step therapy:

Utilization Management

For certain prescription drugs, IU Health Plans (HMO) (HMOPOS) has additional requirements for coverage or limits on coverage. These requirements and limits ensure that members use these drugs in the most effective way and to control drug costs. A team of doctors and pharmacists developed these requirements and limits.

Examples of utilization management tools are described below:

  1. Prior Authorization: IU Health Plans (HMO) (HMOPOS) requires you to get prior authorization for certain drugs. This means that approval is required prior to coverage. If you do not get approval, we may not cover the drug.
  2. Quantity Limits: For certain drugs, IU Health Plans (HMO) (HMOPOS) limits the amount of the drug that we will cover per prescription or for a defined period of time.
  3. Step Therapy: In some cases, we require you to first try one drug to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both effectively treat a medical condition, we may require your doctor to prescribe Drug A first. If Drug A does not work for you, then we will cover Drug B.
  4. Generic Substitution: When there is a generic version of a brand-name drug available, network pharmacies will automatically give you the generic version, unless your doctor has told IU Health Plans (HMO) (HMOPOS) that you must take the brand-name drug and have obtained a prior authorization.

You can find out if the drug you take is subject to these additional requirements or limits by looking in the Formulary. If your drug is subject to one of these additional restrictions or limits and your physician determines that you aren’t able to meet the additional restriction or limit for medical necessity reasons, you or your physician may request an exception (which is a type of coverage determination).

Drug Utilization Review

We conduct drug utilization reviews for our members to make sure that they are getting safe and appropriate medications. These reviews are especially important for members who go to more than one doctor and/or pharmacy for their medications. We conduct drug utilization reviews each time you fill a prescription and on a regular basis by reviewing our records.

During these reviews, we look for medication problems such as:

If we identify a medication problem during our drug utilization review, we will work with you and your doctor to correct the problem.

Disclaimer

IU Health Plans is a Medicare Advantage organization with a Medicare contract. Continued enrollment depends on the contract between CMS and the Plan/Part D Sponsor remaining in effect, i.e. being renewed and not terminated. Other pharmacies/physicians/providers are available in our network. Product types include HMO and HMO-POS.

The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.

Our hours of operation change throughout the year. We are available to take your call: Oct. 1 through March 31 from 8am to 8pm, seven days a week and April 1 through Sept. 30 from 8am to 8pm, Monday through Friday.