Pharmacy

IMPORTANT MESSAGE ABOUT PHARMACY BENEFIT CHANGE

Starting October 1, 2011, CareSource will pay for your prescription drugs and some prescription medical supplies at the pharmacy (diabetic supplies, inhaler spacers, peak flow meters, syringes, needles, alcohol wipes, and condoms). This means that you will need to get your prescription drugs at a pharmacy that accepts CareSource.

CareSource is sending new ID cards to all CareSource members because of the change being made by Ohio Medicaid. Some of the information that pharmacies need will change on October 1, 2011. Please continue to use your current CareSource ID card through September 30.

On October 1, please begin using your new ID card. Please throw away your old ID card once you start using the new one. You must use your new ID card to get prescriptions at the pharmacy and to get other health care through CareSource starting October 1.

The new card will let pharmacies know that CareSource will now pay for your prescriptions. Other changes in your prescription program that you should know about are:

  • You now have no co-payments for your prescriptions.
  • You may have to go to a different pharmacy to get your prescriptions.
  • The prior authorization requirements for your prescriptions may change.

If you have questions about your prescription drug coverage or problems with your pharmacy, call CareSource Member Services at 1-800-993-0780 (TTY: 1-800-750-0750 or 711).

Prescription Drug Coverage

CareSource covers all medically necessary Medicaid-covered drugs at many pharmacies. As a CareSource member, you have no co-pays.

You can get your prescription drugs at any pharmacy that accepts CareSource. Find a Pharmacy near you. Simply type in your address and follow the prompts.

CareSource uses a Preferred Drug List also called a PDL. These are drugs that we prefer our providers prescribe and does not represent all of the drugs covered by Ohio Medicaid. For some drugs, we may also require that your doctor send us information called a Prior Authorization Request. This explains why a certain drug and/or a certain amount of drug is needed. We must approve the request before you can get the drug. Reasons for a Prior Authorization 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 drug, we will send you information on how you can Appeal Our Decision and your right to a state hearing.

You can see our Preferred Drug List (PDL) here. You can also see All Drugs That Require Prior Authorization. You can also call Member Services to ask about our PDL, Prior Authorization List or any CareSource services.

Some out-of-state pharmacies do not accept CareSource, but most national chain drug stores do. If you plan to travel out-of-state, be sure to fill your prescriptions before you leave.

CareSource also covers many commonly-used over-the-counter (OTC) medications with a written prescription by your doctor.

Starting June 15, 2011

Some drugs, called "specialty" drugs are managed by CareSource, not Ohio Medicaid. Some specialty drugs given in your doctor's office may require prior authorization.

Starting June 15, 2011, your doctor will need to get approval from CareSource first for these specialty drugs. CareSource will work with your doctor to make sure that you get the drugs you need. Your health is always our top priority.

If you have questions about these specialty drugs, call CareSource at 1-800-993-0780 (TTY: 1-800-750-0750).