Your network providers

Primary Care Physician (PCP) Directory
Specialty Provider Directory 
 

Your pharmacies and covered drugs

P H A R M A C I E S
IHN has a national network of contracted pharmacies.  Most major chain pharmacies and many independently-owned pharmacies are contracted with IHN and can fill prescriptions for our members. To find out about a specific pharmacy please contact Customer Service for help.

F O R M U L A R Y
Your IHN Formulary contains a listing of covered drugs, prior authorization requirements and any drug quantity limits. This formulary does not contain the names of all medications available in the market. If your medication is not listed, please contact Customer Service for assistance.
2012 Formulary

Your member forms

Hearing Request Form: Request an Administrative Hearing from Department of Medical Assistance Programs (DMAP).

IHN Appeal Request Form: Request a medical appeal with IHN.

Administrative Hearing or Appeal Request Instructions: How to request an Administrative Hearing or an Appeal 

Medication Exception & Authorization Form: Request medically necessary medications that are not normally covered on IHN’s formulary and for medications that require prior authorization.

Prescription Reimbursement Form: Request reimbursement for covered medications that you have received and paid for out of your pocket.

Primary Care Provider (PCP) Change Card: Choose or change a PCP.

Prior Authorization-Referral Form: Request an authorization for medical services.

Authorized Representative Form: You have the right to choose an Authorized Representative.

Request for Health Plan Records Form: This form is required to be completed when  you are requesting any Health Plan documentation from us.