ABD Pharmacy Program
ABD Members transitioning from fee-for-service Medicaid
We want you to get the prescription drugs that you need, when you need them.
Aged, Blind or Disabled (ABD) consumers enrolling from traditional fee-for-service (FFS) Medicaid to CareSource are able to receive their prescription drugs as they did under traditional FFS Medicaid for the first 30 days after enrolling in CareSource. This means that if you needed a prior authorization under traditional Medicaid to get your prescription medication you will most likely still need a prior authorization to get that medication.
If you did not need a prior authorization for your medication under FFS Medicaid you will not need prior authorization by CareSource for the first 30 days you are enrolled. After this transition period you must follow CareSource’s prior authorization requirements to continue receiving your medications.
CareSource’s ABD prior authorization (PA) drug list identifies all drugs that will require prior authorization once you have been a managed care member for more than 30 days. Speak with your doctor about your medications and whether alternative medications that do not require prior authorization may be an option for you.
If you are not sure when you will need to have your medication prior authorized or you have other questions about continuing to get your medication, call member services at
1-800-993-0780 (TTY: 1-800-750-0750).
ABD Prescription Drug Coverage
While CareSource covers all medically necessary Medicaid-covered medications, we use a prefered drug list, also called a PDL. These are the drugs that we prefer that your doctor prescribe. We may also require that your doctor submit information to us (a prior authorization request) to explain why a specific medication and/or a certain amount of a medication is needed. We must approve the request before you can get the medication. Reasons why we may prior authorize a drug include:
- There is a generic or pharmacy alternative drug available
- The drug can be misused/abused
- There are other drugs that must be tried first
If we do not approve a prior authorization request for a medication, we will send you information on how you can appeal our decision and your right to a state hearing.
Click here to view our prefered drug list. Or view all drugs that require prior authorization. Or call member services to request information on our PDL.
Please call our service center at 1-800-993-0780 (TTY 1-800-750-0750):
- For more information
- To find out how to appeal a decision
- To ask if your drug is covered
You should not pay for any drugs covered by CareSource .