CareSource Medicaid Pharmacy Information

If there is a major change to the formulary or the Preferred Drug List (PDL), we will notify members and providers. Participating CareSource physicians are notified annually of all changes to the drugs included in the PDL.

Drugs listed in the drug list are covered. In general, this includes:

  • Most generic medications
  • Limited over-the-counter, medically necessary medications when prescribed in writing by a licensed medical practitioner
  • One generic 90-day smoking cessation treatment per year

Providers can download CareSource's Preferred Drug List to your PDA from ePocrates.

Some formulary drugs have requirements such as:

  • Prior Authorization. To request a Prior Authorization for a drug during business hours, please call Provider Services at 1-800-390-7102 and follow the prompts to speak with the pharmacy department. You may also fill out the Drug Prior Authorization Request Form.
  • Step therapy requires that Members try a first-line medication generally accepted as therapeutically equivalent before providers can prescribe a second-line medication.
  • Quantity limits have been established on some drugs to align with treatment protocols, and help reduce overutilization and abuse.

Please be sure to check our list of drugs that require Prior Authorization.

Drugs that CareSource does not cover include:

  • Brand name drugs when a generic is available
  • Fertility, cosmetic or weight-loss drugs
  • Any drug that may be obtained without charge under other local, state or federal programs
  • Any drug labeled "Caution: Limited by federal law to investigational use"

Prior Authorization is required for any drug not on our Preferred Drug List.

Co-payments

Please remember, no CareSource member should be charged a co-payment for any prescription.

For more information, please call Provider Services at 1-800-390-7102 or see the Provider Manual.

Helpful Substance Abuse and Mental Health Resources for member care.

e-Prescribing

Help reduce errors and improve patient safety

As a health care leader, CareSource is committed to making it easier for you to work with us. e-Prescribing refers to the use of a secure network so that prescribers can share patient prescription information.

Benefits of e-Prescribing:

  • You can check the CareSource formulary at the time of patient contact
  • Save time and money with fewer pharmacy calls and faxes
  • Fewer medication errors and harmful drug allergies or interactions
  • Better health outcomes, improved overall quality of care and enhanced patient safety
  • Automated prescription renewal and authorization

e-Prescribe and receive higher reimbursement from Medicare

Physicians who prescribe for Medicare patients and who adopt qualified electronic prescribing systems are eligible for an increase in reimbursement, starting January 1, 2009. Medicare will provide eligible physicians with a two percent incentive payment for reporting years 2009 and 2010, a one percent incentive payment for reporting years 2011 and 2012, and a one-half percent incentive payment in reporting year 2013. A physician could receive up to a 1.5 percent pay boost for 2009.

For more information about the Medicare e-Prescribing incentive program you can download "Medicare's Practical Guide to the e-Prescribing Incentive Program" or visit the Medicare e-Prescribing incentive program information page.