Pharmacy Policies

These clinical and administrative policies apply to our Indiana plans on the Health Insurance Marketplace.

Pharmacy policies offer guidance on determination of coverage of pharmaceutical products. The coverage criteria are consistent with FDA-approved prescribing information, treatment guidelines and literature. The policies listed on this page are not inclusive of all pharmaceutical products. New policies will be added as new pharmaceutical products become available or as needed. Existing policies are regularly reviewed and updated to reflect current treatment guidelines and prescribing information. 

The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.

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Archived Pharmacy Policies