Per Indiana rule 405 IAC 5-24-8(a) prior authorization will be required for substitutable brand name drugs.

Beginning on January 11, 2016, MDwise Medicaid (Healthy Indiana Plan and Hoosier Care Connect) prescriptions for which the prescriber has indicated "Brand Medically Necessary" will follow a new procedure for review and determination. Pharmacies will no longer be able to submit the claim with a DAW code of 6 or 9 for these prescriptions. For consideration of ‘Brand Medically Necessary’ claims, the prescriber will be required to submit a prior authorization request. Those requests will be considered within 24 hours.

Prescribers should use the attached form to submit these requests, also found on the MDwise website, mdwise.org.

BIN: 003585

PCN: ASPROD1

GRP: MDW

Please download attached PDF file for more information.