E-Prescribing, Formulary Searching, and Exception (PA) Requests for MDwise Plans
E-Prescribing
Together with its Pharmacy Benefits Manager (PBMs, MedImpact), 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 PBM enables physicians to write an informed prescription at the point of care. The MDwise PBM interfaces with e-prescribing connectivity vendors to deliver these services to physicians who treat MDwise members. [insert link here for the remainder of content]
MDwise e-prescribing applications enable a prescriber to use a computer or hand-held device to:
- Electronically Access the Patient’s Prescription Benefit
- 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.
- Prescribers can also choose lower-cost alternatives such as generic drugs.
- 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
- 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).
- 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
- Exchanging prescription information electronically between prescribers and pharmacies improves the accuracy of the prescribing process
- 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.
Online Formulary Search
MDwise Formularies may be accessed online by visiting
- From the MDwise home page, click on the ‘For Providers’ tab on the horizontal bar across the top of the page.
Online Formulary Searchcont.
- Next, select one of the Quick Links along the right side of the page:
- Formulary for MDwise Marketplace
- Formulary for Hoosier Care Connect
- Formulary for HIP Plans
- Next, select ‘Find a drug’ under the applicable MDwise Plan.
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- You may search the applicable MDwise Formulary by typing the drug name in the search box.
- Or you may search by Therapeutic Class by selecting the desired therapeutic class from the list of options.
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- Once the search has been executed, all available strengths in both brand and generic (if available) will be listed.
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- By clicking on an individual medication from the options listed as described above, additional details will be provided such as the therapeutic class, status (ie. formulary tier or status), and additional notes & restrictions.
- Select the icon(s) in the ‘Notes & Restrictions’ section to show additional details about the note or restriction.
Online Formulary Search cont.
- Further, therapeutic alternatives may be viewed by clicking on the drug class in the ‘Therapeutic Class’ section.
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- Once the alternatives are displayed, click on the desire drug class to view formulary options (listed in alphabetical order)
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 & Hoosier Care Connect: 1-800-356-1204
MDwise Marketplace: 855-417-5615
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, Hoosier Care Connect, and MDwise Marketplace
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 (800-788-2949) 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 858-790-7100. This line operates 24 hours per day, 7 days per week, 365 days per year. In addition, the MedImpact Contact Center staff is available on a toll free phone line (HIP/HCC 844-336-2677; MDwise Marketplace 844-336-2684) 24 hours per day, 7 days per week, and 365 days per year to answer questions about the status of a request.
Accessing MRFS (Medication Request Forms)
MDwise MRFS may be accessed online by visiting
- From the MDwise home page, click on the ‘For Providers’ tab on the horizontal bar across the top of the page.
Accessing MRFS (Medication Request Forms) cont.
- Next, select ‘Forms’ along the left side of the page:
- Then, select ‘Pharmacy’along the left side of the page:
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- All available MRFs are listed.
- Healthy Indiana Plan and Hoosier Care Connect have Drug Specific and Drug Category Specific MRFs, as well as forms for all other drugs and BMN (Brand Medically Necessary) Medication requests.
- MDwise Marketplace does not have Drug or Drug Category Specific MRFS. There is a form for all drugs with the exception BMN Medication requests.
- For Brand Medically Necessary Medication requests, the FDA MedWatch form must accompany the MRF when submitting to MedImpact for review for Healthy Indiana Plan, Hoosier Care Connect, and MDwise Marketplace. A link to the MedWatch form is provided on the MRF.
Accessing MRFs (Medication Request Forms) cont.
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 & Hoosier Care Connect: 1-800-356-1204
MDwise Marketplace: 855-417-5615
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