Common use of SUPDL and Formulary Requirements Clause in Contracts

SUPDL and Formulary Requirements. For purposes of this section, the “formulary” is defined as the SUPDL and “non- formulary” is defined as covered outpatient drugs not included in the SUPDL. The Contractor shall maintain formulary (i.e., SUPDL) and covered non-formulary (i.e., non-SUPDL) drug lists for the Hoosier Care Connect packages. The Contractor must use the SUPDL as its formulary and may not develop and use its own PDL for any therapeutic categories that are part of the SUPDL. The Contractor will be provided opportunities to offer feedback on the SUPDL to the State. The State shall provide the Contractor with fifteen (15) calendar days’ notice of any change to the SUPDL, except those changes resulting from a drug shortage, recall or discontinuation, and the Contractor shall have an additional fifteen (15) calendar days to implement the change, including any system change. A drug that is on the SUPDL must have the same criteria and forms as the FFS PDL even if it is reimbursed as a medical claim. The Contractor shall submit any changes to the contents of the approved non- formulary drug list and any changes to prior authorization or medical necessity criteria applied to the non-formulary drug list to OMPP at least 60 days prior to the intended implementation date. OMPP may disapprove or modify the proposed changes within 30 days of receipt. If no response is received from OMPP within 30 days, the Contractor may implement the proposed changes. The formulary and non-formulary covered drug lists shall support the coverage and non-coverage requirements for legend and non-legend drugs by Indiana Medicaid. More information can be found in 405 IAC 5-24-3, 405 IAC 5-24-4, 405 IAC 5-24-5 and 407 IAC 3-10-1. In accordance with CMS-2390-F and 42 CFR 438.210, the Contractor shall demonstrate prescription drug coverage consistent with the amount, duration, and scope of the fee-for-service program. Per 42 CFR § 423.100, prescription drug coverage means coverage of Part D drugs that is either standard prescription drug coverage or basic alternative coverage. The Contractor shall follow the SUPDL prior authorization criteria for SUPDL drug classes. Per 42 CFR § 419.81, preauthorization (or prior authorization) means the process through which a request for provisional affirmation of coverage is submitted to CMS or its contractors for review before the service is provided to the beneficiary and before the claim is submitted for processing. Per 42 CFR 438.10(i)(1)-(2), the Contractor shall make available in electronic or paper form, the covered drug list(s) of medications including the reference brand and generic names of each drug as well as what tier each drug is on. The Contractor shall utilize a Pharmacy and Therapeutics Committee which shall meet regularly to make recommendations for changes to non-formulary covered outpatient drugs. The Contractor shall maintain an Over-the-Counter (OTC) Drug Formulary and Contraception Formularies and a Pharmacy Supplements Formulary which contains, at a minimum, the same items included in the FFS OTC Drug Formulary and Contraception Formularies and the Pharmacy Supplements Formulary and as updated by the DUR Board. Any additions to the Contractor OTC Drug Formulary are required to only be from participating rebating labelers. The formulary (i.e., SUPDL) and non-formulary (i.e., non-SUPDL) covered drug lists shall be made readily available to providers in the Contractor’s network and to members by linking to the Pharmacy Services page on xxxxx://xxx.xx.xxx/medicaid/. The formulary and non-formulary covered drug lists shall be updated and posted on or before the intended implementation date to reflect all changes in the status of a drug or addition of new drugs. The Contractor shall also support e-Prescribing technologies to communicate the formulary SUPDL and non-formulary drug lists and covered drugs to prescribers through electronic medical records (EMRs) and e- Prescribing applications. Refer to Section 3.8.5 for additional requirements on e- Prescribing. Consistent with the requirements of Section 6.8, the Contractor shall develop provider education and outreach aimed at educating providers about the Hoosier Care Connect formulary as well as the utilization of e-Prescribing technologies to ensure appropriate prescribing for members based on the member’s benefit plan. The Contractor shall assure that non-drug products approved for use in compounding are not subject to rebating manufacturer requirements.

SUPDL and Formulary Requirements. For purposes of this section, the “formulary” is defined as the SUPDL SUPDL, and “non- formulary” is defined as covered outpatient drugs not included in the SUPDL. The Contractor shall maintain formulary (i.e., SUPDL) and covered non-formulary (i.e., non-SUPDL) drug lists for the Contractor’s Hoosier Care Connect Healthwise packages. The Contractor must use the SUPDL as its formulary and may not develop and use its own PDL for any therapeutic categories that are part of the SUPDL. The Contractor will be provided opportunities to offer feedback on the SUPDL to the State. The State shall provide the Contractor with fifteen (15) calendar days’ notice of any change to the SUPDL, except those changes resulting from a drug shortage, recall or discontinuation, and the Contractor shall have an additional fifteen (15) calendar days to implement the change, including any system change. A drug that is on the SUPDL must have the same criteria and forms as the FFS PDL even if it is reimbursed as a medical claim. The Contractor shall submit any changes to the contents of the approved non- formulary drug list and any changes to prior authorization or medical necessity criteria applied to the non-formulary drug list to OMPP at least 60 days prior to the intended implementation date. OMPP may disapprove or modify the proposed changes within 30 days of receipt. If no response is received from OMPP within 30 days, the Contractor may implement the proposed changes. The formulary and non-formulary covered drug lists shall support the coverage and non-coverage requirements for legend and non-legend drugs by Indiana Medicaid. More information can be found in 405 IAC 5-24-3, 405 IAC 5-24-4, 405 IAC 5-24-5 and 407 IAC 3-10-1. In accordance with CMS-2390-F and 42 CFR 438.210, the Contractor shall demonstrate prescription drug coverage consistent with the amount, duration, and scope of the fee-for-service program. Per 42 CFR § 423.100, prescription drug coverage means coverage of Part D drugs that is either standard prescription drug coverage or basic alternative coverage. The Contractor shall follow the SUPDL prior authorization criteria for SUPDL drug classes. Per 42 CFR § 419.81, preauthorization (or prior authorization) means the process through which a request for provisional affirmation of coverage is submitted to CMS or its contractors for review before the service is provided to the beneficiary and before the claim is submitted for processing. Per 42 CFR 438.10(i)(1)-(2), the Contractor shall make available in electronic or paper form, the covered drug list(s) of medications including the reference brand and generic names of each drug as well as what tier each drug is on. The Contractor shall utilize a Pharmacy and Therapeutics Committee which shall meet regularly to make recommendations for changes to non-formulary covered outpatient drugs. The Contractor shall maintain an Over-the-Over the Counter (OTC) Drug Formulary and Contraception Formularies and a Pharmacy Supplements Formulary which contains, at a minimum, the same items included in the FFS OTC Drug Formulary and Contraception Formularies and the Pharmacy Supplements Formulary and as updated by the DUR Board. Any additions to the Contractor OTC Drug Formulary are required to only be from participating rebating labelers. The formulary (i.e., SUPDL) and non-formulary (i.e., non-SUPDL) covered drug lists shall be made readily available to providers in the Contractor’s network and to members by linking to the Pharmacy Services page on xxxxx://xxx.xx.xxx/medicaid/. The formulary and non-formulary covered drug lists shall be updated and posted on or before the intended implementation date to reflect all changes in the status of a drug or addition of new drugs. The Contractor shall also support e-Prescribing technologies to communicate the formulary SUPDL and non-formulary drug lists and covered drugs to prescribers through electronic medical records (EMRs) and e- Prescribing applications. Refer to Section 3.8.5 3.4.5 for additional requirements on e- Prescribing. Consistent with the requirements of Section 6.85.7, the Contractor shall develop provider education and outreach aimed at educating providers about the Hoosier Care Connect Healthwise formulary as well as the utilization of e-Prescribing technologies to ensure appropriate prescribing for members based on the member’s benefit plan. The Contractor shall assure that non-drug products approved for use in compounding are not subject to rebating manufacturer requirements. Also, prescriptions obtained by a Hoosier Healthwise member that are not otherwise exempt, are subject to the copayment amounts set forth in Section 3.4.11. Copayments assessed to the Hoosier Healthwise member at the point of sale may not exceed the total cost of the drug.

SUPDL and Formulary Requirements. For purposes of this section, the “formulary” is defined as the SUPDL and “non- formulary” is defined as covered outpatient drugs not included in the SUPDL. The Contractor shall maintain a formulary (i.e., SUPDL) and covered non-formulary (i.e., non-SUPDL) drug lists for the Hoosier Care Connect Contractor’s PathWays packages. The Contractor must use the SUPDL as its formulary and may not develop and use its own PDL for any therapeutic categories that are part of the SUPDL. The Contractor will be provided opportunities to offer feedback on the SUPDL to the State. The State shall provide the Contractor with fifteen thirty (1530) calendar days’ notice of any change to the SUPDL, except those changes resulting from a drug shortage, recall or discontinuation, and the Contractor shall have an additional fifteen thirty (1530) calendar days to implement the change, including any system change. A drug that is on the SUPDL must have the same criteria and forms as the FFS PDL even if it is reimbursed as a medical claim. The Contractor shall submit any changes to the contents of the approved non- formulary drug list and any changes to prior authorization or medical necessity criteria applied to the non-formulary drug list to OMPP at least 60 days prior to the intended implementation date. OMPP may disapprove or modify the proposed changes within 30 days of receipt. If no response is received from OMPP within 30 days, the Contractor may implement the proposed changes. The PathWays formulary and non-formulary covered drug lists shall support the coverage and non-non- coverage requirements for legend and non-legend drugs by Indiana Medicaid. More information can be found in 405 IAC 5-24-3, 405 IAC 5-24-4, 405 IAC 5-24-5 and 407 IAC 3-10-1. In accordance with CMS-2390-F and 42 CFR 438.210, the Contractor shall demonstrate prescription drug coverage consistent with the amount, duration, and scope of the fee-for-service program. Per 42 CFR § 423.100, prescription drug coverage means coverage of Part D drugs that is either standard prescription drug coverage or basic alternative coverage. The Contractor shall engage with the State process to develop universal medically necessary prior authorization criteria for IHCP. The Contractor shall follow the SUPDL prior authorization criteria for SUPDL drug classes. Per 42 CFR § 419.81, preauthorization (or prior authorization) means the process through which a request for provisional affirmation of coverage is submitted to CMS or its contractors for review before the service is provided to the beneficiary and before the claim is submitted for processing. Per 42 CFR 438.10(i)(1)-(2), the Contractor shall make available in electronic or paper form, the covered drug list(s) of medications including the reference brand and generic names of each drug as well as what tier each drug is on. The Contractor shall implement the universal IHCP criteria into their program and may not utilize a Pharmacy and Therapeutics Committee which shall meet regularly to make recommendations for changes to nonmore restrictive criteria. At least thirty-formulary covered outpatient drugs. The Contractor shall maintain an Over-the-Counter five (OTC35) Drug Formulary and Contraception Formularies and a Pharmacy Supplements Formulary which contains, at a minimum, days before the same items included in intended implementation date of the FFS OTC Drug Formulary and Contraception Formularies and the Pharmacy Supplements Formulary and as updated by the DUR Board. Any additions to the Contractor OTC Drug Formulary are required to only be from participating rebating labelers. The formulary (i.e., SUPDL) and non-formulary (i.e., non-SUPDL) covered drug lists shall be made readily available to providers in the Contractor’s network and to members by linking to the Pharmacy Services page on xxxxx://xxx.xx.xxx/medicaid/. The initial formulary and non-formulary covered drug list, the Contractor shall submit its proposed formulary and non-formulary lists to OMPP. The OMPP shall be updated submit the formulary and posted on or before non-formulary to the intended implementation date to reflect all changes in the status of a drug or addition of new drugsDrug Utilization Review (DUR) Board for review and recommendation. The Contractor shall also support e-Prescribing technologies be accessible to communicate the formulary SUPDL and non-formulary drug lists and covered drugs DUR Board to prescribers through electronic medical records (EMRs) and e- Prescribing applications. Refer respond to Section 3.8.5 for additional requirements on e- Prescribing. Consistent with the requirements of Section 6.8, the Contractor shall develop provider education and outreach aimed at educating providers about the Hoosier Care Connect formulary as well as the utilization of e-Prescribing technologies to ensure appropriate prescribing for members based on the member’s benefit plan. The Contractor shall assure that non-drug products approved for use in compounding are not subject to rebating manufacturer requirements.EXHIBIT 1

SUPDL and Formulary Requirements. For purposes of this section, the “formulary” is defined as the SUPDL and “non- formulary” is defined as covered outpatient drugs not included in the SUPDL. The Contractor shall maintain formulary (i.e., SUPDL) and covered non-formulary (i.e., non-SUPDL) drug lists for the Contractor’s Hoosier Care Connect Healthwise packages. The Contractor must use the SUPDL as its formulary and may not develop and use its own PDL for any therapeutic categories that are part of the SUPDL. The Contractor will be provided opportunities to offer feedback on the SUPDL to the State. The State shall provide the Contractor with fifteen (15) calendar days’ notice of any change to the SUPDL, except those changes resulting from a drug shortage, recall or discontinuation, and the Contractor shall have an additional fifteen fift een (15) calendar days to implement the change, including any system change. A drug that is on the SUPDL must have the same criteria and forms as the FFS PDL even if it is reimbursed as a medical claim. The Contractor shall submit any changes to the contents of the approved non- formulary drug list and any changes to prior authorization or medical necessity criteria applied to the non-formulary drug list to OMPP at least 60 days prior to the intended implementation date. OMPP may disapprove or modify the proposed changes within 30 days of receipt. If no response is received from OMPP within 30 days, the Contractor may implement the proposed changes. The formulary and non-formulary covered drug lists shall support the coverage and non-coverage requirements for legend and non-legend drugs by Indiana Medicaid. More information can be found in 405 IAC 5-24-3, 405 IAC 5-24-4, 405 IAC 5-24-5 5, and 407 405 IAC 313-10-19. In accordance with CMS-2390-F and 42 CFR 438.210, the Contractor shall demonstrate prescription drug coverage consistent with the amount, duration, and scope of the fee-for-service program. Per 42 CFR § 423.100, prescription drug coverage means coverage of Part D drugs that is either standard prescription drug coverage or basic alternative coverage. The Contractor shall follow the SUPDL prior authorization criteria for SUPDL drug classes. Per 42 CFR § 419.81, preauthorization (or prior authorization) means the process through which a request for provisional affirmation of coverage is submitted to CMS or its contractors for review before the service is provided to the beneficiary and before the claim is submitted for processing. Per 42 CFR 438.10(i)(1)-(2), the Contractor shall make available in electronic or paper form, the covered drug list(s) of medications including the reference brand and generic names of each drug as well as what tier each drug is on. The Contractor shall utilize a Pharmacy and Therapeutics Committee which shall meet regularly to make recommendations for changes to non-formulary covered outpatient drugs. The Contractor shall maintain an Over-the-Counter (OTC) Drug Formulary and Contraception Formularies and a Pharmacy Supplements Formulary which contains, at a minimum, the same items included in the FFS OTC Drug Formulary and Contraception Formularies and the Pharmacy Supplements Formulary and as updated by the DUR Board. Any additions to the Contractor OTC Drug Formulary are required to only be from participating rebating labelers. EXHIBIT 1B SCOPE OF WORK The formulary (i.e., SUPDL) and non-formulary (i.e., non-SUPDL) covered drug lists shall be made readily available to providers in the Contractor’s network and to members by linking to the Pharmacy Services page on xxxxx://xxx.xx.xxx/medicaid/. The formulary and non-formulary covered drug lists shall be updated and posted on or before the intended implementation date to reflect all changes in the status of a drug or addition of new drugs. The Contractor shall also support e-Prescribing technologies to communicate the formulary SUPDL and non-formulary drug lists and covered drugs to prescribers through electronic medical records (EMRs) and e- e-Prescribing applications. Refer to Section 3.8.5 3.4.5 for additional requirements on e- e-Prescribing. Consistent with the requirements of Section 6.85.7, the Contractor shall develop provider education and outreach aimed at educating providers about the Hoosier Care Connect Healthwise formulary as well as the utilization of e-Prescribing technologies to ensure appropriate prescribing for members based on the member’s benefit plan. The Contractor shall assure that non-drug products approved for use in compounding are not subject to rebating manufacturer requirements.. Also, prescriptions obtained by a Hoosier Healthwise member that are not otherwise exempt, are subject to the copayment amounts set forth in Section

SUPDL and Formulary Requirements. For purposes of this section, the “formulary” is defined as the SUPDL and “non- formulary” is defined as covered outpatient drugs not included in the SUPDL. The Contractor shall maintain formulary (i.e., SUPDL) and covered non-formulary (i.e., non-SUPDL) drug lists for the Contractor’s Hoosier Care Connect Healthwise packages. The Contractor must use the SUPDL as its formulary and may not develop and use its own PDL for any therapeutic categories that are part of the SUPDL. The Contractor will be provided opportunities to offer feedback on the SUPDL to the State. The State shall provide the Contractor with fifteen (15) calendar days’ notice of any change to the SUPDL, except those changes resulting from a drug shortage, recall or discontinuation, and the Contractor shall have an additional fifteen fift een (15) calendar days to implement the change, including any system change. A drug that is on the SUPDL must have the same criteria and forms as the FFS PDL even if it is reimbursed as a medical claim. The Contractor shall submit any changes to the contents of the approved non- formulary drug list and any changes to prior authorization or medical necessity criteria applied to the non-formulary drug list to OMPP at least 60 days prior to the intended implementation date. OMPP may disapprove or modify the proposed changes within 30 days of receipt. If no response is received from OMPP within 30 days, the Contractor may implement the proposed changes. The formulary and non-formulary covered drug lists shall support the coverage and non-coverage requirements for legend and non-legend drugs by Indiana Medicaid. More information can be found in 405 IAC 5-24-3, 405 IAC 5-24-4, 405 IAC 5-24-5 5, and 407 405 IAC 313-10-19. In accordance with CMS-2390-F and 42 CFR 438.210, the Contractor shall demonstrate prescription drug coverage consistent with the amount, duration, and scope of the fee-for-service program. Per 42 CFR § 423.100, prescription drug coverage means coverage of Part D drugs that is either standard prescription drug coverage or basic alternative coverage. The Contractor shall follow the SUPDL prior authorization criteria for SUPDL drug classes. Per 42 CFR § 419.81, preauthorization (or prior authorization) means the process through which a request for provisional affirmation of coverage is submitted to CMS or its contractors for review before the service is provided to the beneficiary and before the claim is submitted for processing. Per 42 CFR 438.10(i)(1)-(2), the Contractor shall make available in electronic or paper form, the covered drug list(s) of medications including the reference brand and generic names of each drug as well as what tier each drug is on. EXHIBIT 1B SCOPE OF WORK The Contractor shall utilize a Pharmacy and Therapeutics Committee which shall meet regularly to make recommendations for changes to non-formulary covered outpatient drugs. The Contractor shall maintain an Over-the-Counter (OTC) Drug Formulary and Contraception Formularies and a Pharmacy Supplements Formulary which contains, at a minimum, the same items included in the FFS OTC Drug Formulary and Contraception Formularies and the Pharmacy Supplements Formulary and as updated by the DUR Board. Any additions to the Contractor OTC Drug Formulary are required to only be from participating rebating labelers. The formulary (i.e., SUPDL) and non-formulary (i.e., non-SUPDL) covered drug lists shall be made readily available to providers in the Contractor’s network and to members by linking to the Pharmacy Services page on xxxxx://xxx.xx.xxx/medicaid/. The formulary and non-formulary covered drug lists shall be updated and posted on or before the intended implementation date to reflect all changes in the status of a drug or addition of new drugs. The Contractor shall also support e-Prescribing technologies to communicate the formulary SUPDL and non-formulary drug lists and covered drugs to prescribers through electronic medical records (EMRs) and e- e-Prescribing applications. Refer to Section 3.8.5 3.4.5 for additional requirements on e- e-Prescribing. Consistent with the requirements of Section 6.85.7, the Contractor shall develop provider education and outreach aimed at educating providers about the Hoosier Care Connect Healthwise formulary as well as the utilization of e-Prescribing technologies to ensure appropriate prescribing for members based on the member’s benefit plan. The Contractor shall assure that non-drug products approved for use in compounding are not subject to rebating manufacturer requirements.. Also, prescriptions obtained by a Hoosier Healthwise member that are not otherwise exempt, are subject to the copayment amounts set forth in Section

SUPDL and Formulary Requirements. For purposes of this section, the “formulary” is defined as the SUPDL and “non- formulary” is defined as covered outpatient drugs not included in the SUPDL. The Contractor shall maintain formulary (i.e., SUPDL) and covered non-formulary (i.e., non-SUPDL) drug lists for the Hoosier Care Connect packages. The Contractor must use the SUPDL as its formulary and may not develop and use its own PDL for any therapeutic categories that are part of the SUPDL. The Contractor will be provided opportunities to offer feedback on the SUPDL to the State. The State shall provide the Contractor with fifteen (15) calendar days’ notice of any change to the SUPDL, except those changes resulting from a drug shortage, recall or discontinuation, and the Contractor shall have an additional fifteen fift een (15) calendar days to implement the change, including any system change. A drug that is on the SUPDL must have the same criteria and forms as the FFS PDL even if it is reimbursed as a medical claim. The Contractor shall submit any changes to the contents of the approved non- formulary drug list and any changes to prior authorization or medical necessity criteria applied to the non-formulary drug list to OMPP at least 60 days prior to the intended implementation date. OMPP may disapprove or modify the proposed changes within 30 days of receipt. If no response is received from OMPP within 30 days, the Contractor may implement the proposed changes. The formulary and non-formulary covered drug lists shall support the coverage and non-coverage requirements for legend and non-legend drugs by Indiana Medicaid. More information can be found in 405 IAC 5-24-3, 405 IAC 5-24-4, 405 IAC 5-24-5 and 407 405 IAC 313-10-19. In accordance with CMS-2390-F and 42 CFR 438.210, the Contractor shall demonstrate prescription drug coverage consistent with the amount, duration, and scope of the fee-for-service program. Per 42 CFR § 423.100, prescription drug coverage means coverage of Part D drugs that is either standard prescription drug coverage or basic alternative coverage. The Contractor shall follow the SUPDL prior authorization criteria for SUPDL drug classes. Per 42 CFR § 419.81, preauthorization (or prior authorization) means the process through which a request for provisional affirmation of coverage is submitted to CMS or its contractors for review before the service is provided to the beneficiary and before the claim is submitted for processing. Per 42 CFR 438.10(i)(1)-(2), the Contractor shall make available in electronic or paper form, the covered drug list(s) of medications including the reference brand and generic names of each drug as well as what tier each drug is on. The Contractor shall utilize a Pharmacy and Therapeutics Committee which shall meet regularly to make recommendations for changes to non-formulary covered outpatient drugs. The Contractor shall maintain an Over-the-Counter (OTC) Drug Formulary and Contraception Formularies and a Pharmacy Supplements Formulary which contains, at a minimum, the same items included in the FFS OTC Drug Formulary and Contraception Formularies and the Pharmacy Supplements Formulary and as updated by the DUR Board. Any additions to the Contractor OTC Drug Formulary are required to only be from participating rebating labelers. The formulary (i.e., SUPDL) and non-formulary (i.e., non-SUPDL) covered drug lists shall be made readily available to providers in the Contractor’s network and to members by linking to the Pharmacy Services page on xxxxx://xxx.xx.xxx/medicaid/. The formulary and non-formulary covered drug lists shall be updated and posted on or before the intended implementation date to reflect all changes in the status of a drug or addition of new drugs. The Contractor shall also support e-Prescribing technologies to communicate the formulary SUPDL and non-formulary drug lists and covered drugs to prescribers through electronic medical records (EMRs) and e- Prescribing applications. Refer to Section 3.8.5 for additional requirements on e- Prescribing. Consistent with the requirements of Section 6.8, the Contractor shall develop provider education and outreach aimed at educating providers about the Hoosier Care Connect formulary as well as the utilization of e-Prescribing technologies to ensure appropriate prescribing for members based on the member’s benefit plan. The Contractor shall assure that non-drug products approved for use in compounding are not subject to rebating manufacturer requirements.FFS

SUPDL and Formulary Requirements. For purposes of this section, the “formulary” is defined as the SUPDL SUPDL, and “non- formulary” is defined as covered outpatient drugs not included in the SUPDL. The Contractor shall maintain formulary (i.e., SUPDL) and covered non-formulary (i.e., non-SUPDL) drug lists for the Contractor’s Hoosier Care Connect Healthwise packages. The Contractor must use the SUPDL as its formulary and may not develop and use its own PDL for any therapeutic categories that are part of the SUPDL. The Contractor will be provided opportunities to offer feedback on the SUPDL to the State. The State shall provide the Contractor with fifteen (15) calendar days’ notice of any change to the SUPDL, except those changes resulting from a drug shortage, recall or discontinuation, and the Contractor shall have an additional fifteen (15) calendar days to implement the change, including any system change. A drug that is on the SUPDL must have the same criteria and forms as the FFS PDL even if it is reimbursed as a medical claim. The Contractor shall submit any changes to the contents of the approved non- formulary drug list and any changes to prior authorization or medical necessity criteria applied to the non-formulary drug list to OMPP at least 60 days prior to the intended implementation date. OMPP may disapprove or modify the proposed changes within 30 days of receipt. If no response is received from OMPP within 30 days, the Contractor may implement the proposed changes. The formulary and non-formulary covered drug lists shall support the coverage and non-coverage requirements for legend and non-legend drugs by Indiana Medicaid. More information can be found in 405 IAC 5-24-3, 405 IAC 5-24-4, 405 IAC 5-24-5 and 407 IAC 3-10-1. In accordance with CMS-2390-F and 42 CFR 438.210, the Contractor shall demonstrate prescription drug coverage consistent with the amount, duration, and scope of the fee-for-service program. Per 42 CFR § 423.100, prescription drug coverage means coverage of Part D drugs that is either standard prescription drug coverage or basic alternative coverage. The Contractor shall follow the SUPDL prior authorization criteria for SUPDL drug classes. Per 42 CFR § 419.81, preauthorization (or prior authorization) means the process through which a request for provisional affirmation of coverage is submitted to CMS or its contractors for review before the service is provided to the beneficiary and before the claim is submitted for processing. Per 42 CFR 438.10(i)(1)-(2), the Contractor shall make available in electronic or paper form, the covered drug list(s) of medications including the reference brand and generic names of each drug as well as what tier each drug is on. The Contractor shall utilize a Pharmacy and Therapeutics Committee which shall meet regularly to make recommendations for changes to non-formulary covered outpatient drugs. The Contractor shall maintain an Over-the-Over the Counter (OTC) Drug Formulary and Contraception Formularies and a Pharmacy Supplements Formulary which contains, at a minimum, the same items included in the FFS OTC Drug Formulary and Contraception Formularies and the Pharmacy Supplements Formulary and as updated by the DUR Board. Any additions to the Contractor OTC Drug Formulary are required to only be from participating rebating labelers. The formulary (i.e., SUPDL) and non-formulary (i.e., non-SUPDL) covered drug lists shall be made readily available to providers in the Contractor’s network and to members by linking to the Pharmacy Services page on xxxxx://xxx.xx.xxx/medicaid/. xxxxx://xxx.xx.xxx/medicaid/ . The formulary and non-formulary covered drug lists shall be updated and posted on or before the intended implementation date to reflect all changes in the status of a drug or addition of new drugs. The Contractor shall also support e-Prescribing technologies to communicate the formulary SUPDL and non-formulary drug lists and covered drugs to prescribers through electronic medical records (EMRs) and e- Prescribing applications. Refer to Section 3.8.5 3.4.5 for additional requirements on e- Prescribing. Consistent with the requirements of Section 6.85.7, the Contractor shall develop provider education and outreach aimed at educating providers about the Hoosier Care Connect Healthwise formulary as well as the utilization of e-Prescribing technologies to ensure appropriate prescribing for members based on the member’s benefit plan. The Contractor shall assure that non-drug products approved for use in compounding are not subject to rebating manufacturer requirements. Also, prescriptions obtained by a Hoosier Healthwise member that are not otherwise exempt, are subject to the copayment amounts set forth in Section 3.4.11. Copayments assessed to the Hoosier Healthwise member at the point of sale may not exceed the total cost of the drug.