Pharmacy

Prescription Drugs

While CareSource covers all medically necessary Medicaid-covered medications, we use a preferred drug list (PDL).These are the drugs that we prefer that your doctor prescribe.

We may also require that you have a prior authorization for some medications. This means your doctor must submit information to us to explain why a specific 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

Some drugs may also have quantity (amount) limits and some drugs are never covered, such as drugs for weight loss.

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. You can call member services to request information on our PDL.

Please note, generic drugs must be used unless they don’t work, and your doctor must write “dispense as written” on the prescription. Also, some drugs can be prescribed in larger quantities if your doctor gets a prior authorization.

Participating CareSource physicians have been notified in writing of:

The drugs included on the preferred drug list

How to request a prior authorization

Special procedures set up for urgent requests

If your doctor feels it is medically necessary for you to have a drug that is not on the list, he or she should give CareSource documentation about the drug to request a prior authorization.

If CareSource does not authorize the request, we will notify you and give you information about the CareSource appeal and state hearing process.Please call our service center:

For more information or a list of covered drugs
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.

You can click on RxAmerica’s Find a Pharmacy to find a pharmacy location near you. Simply type in your address.

Serviced by CareSource Management Group