Pharmacy
Prescription drugs
With CareSource, you will have access to all of the CBI-covered prescription drugs your child needs. We provide access to more than 52,000 pharmacies.
CareSource uses a Preferred Drug List (also known as a PDL) to show the drugs we prefer that your doctor prescribe. Some drugs are not covered by the CBI program. Some drugs may also have amount limits.
CareSource will coordinate your child's medical care and prescription drug needs so you can focus on other things for your family.
We know you probably have a lot of questions about CBI prescription drug benefits. Here are some questions we are often asked:
How do I find a pharmacy?
For the most recent listing, click on Find a Pharmacy only to find a pharmacy location near you. Just type in your address and the system will tell you the network pharmacy locations near your home.
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What is a network pharmacy?
We call the pharmacies listed in our Pharmacy Directory our "network pharmacies" because we have agreements with them to provide prescription drugs to our members. A network pharmacy is a pharmacy where members can get prescription drug benefits provided by CareSource.
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Are the doctors in your network aware of your prescription drug benefits?
Yes, participating CareSource physicians have been notified in writing of the drugs included on the formulary as well as the special procedures set up for urgent medication requests.
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How do I find out if my child's drug is covered?
You may review the Preferred Drug List (also known as a PDL), or you can call Member Services at 1-866-415-0584, Monday through Friday, 7 a.m. to 7 p.m. (TTY users should call 1-800-750-0750 or 711). Some drugs may have quantity limits and may require a Prior Authorization.
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Does CareSource require Prior Authorization?
If your doctor feels it is medically necessary for your child to have a drug that is not on the list, he or she will need to ask for a Prior Authorization. Some drugs may have quantity limits and may also require a Prior Authorization. Quantity limits can be found on the Formulary.
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Does CareSource offer both generic and brand name drugs?
CareSource covers both brand name drugs and most generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
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Will the Preferred Drug List (also known as PDL) change?
Yes, please check this web site for updates as the formulary may change from month to month.
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Will I have co-pays for my child's prescription drugs? If so, how much will it be?
Yes. Co-pays may vary by drug. The grid below provides guidelines for how much the prescription drug co-pays will be for your child's medication.
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Most Generic drugs
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Preferred drugs
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All other drugs
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$10
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$22
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$44
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View Formlary
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What happens if my child's medication is lost or stolen?
CareSource will cover lost or stolen medication one time per year and co-pays will apply. CareSource may require approval from your doctor or a police report for certain lost or stolen drugs.
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What if I don't agree with a decision made about my child's prescription drug benefits?
You can file a grievance. A grievance is a complaint that shows you are not satisfied with the plan or pharmacy's service. To find out how to file a grievance, please call Member Services at 1-866-415-0584, Monday through Friday, 7 a.m. to 7 p.m. (TTY users should call 1-800-750-0750 or 711).
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If you have more questions about the CBI prescription drug benefits, please Contact Us.