Pharmacy

CareSource PASSE pays for all medically necessary, CMS participating, Medicaid-covered FDA-approved products on the Preferred Drug List (PDL) at many pharmacies. These are drugs we prefer your provider to prescribe. The PDL can change. Check the Preferred Drug List (PDL) when you need to fill or refill a drug.

Prior Authorization

CareSource PASSE may ask your provider why you need a certain type or dose of medicine. Prior authorization may be needed if:

  • There is a generic or OTC drug.
  • The drug can be misused or abused.
  • There are other drugs that must be tried first.

Some drugs have limits on how much can be given at once. Some drugs are never covered, like drugs for weight loss. If we do not approve a drug, we will tell you how to ask for an appeal of our decision and your right to a state fair hearing.

Find A Pharmacy

To Find a Pharmacy near you, simply type in your city or zip code and follow the prompts. CareSource PASSE pays for all medically necessary, CMS participating, Medicaid-covered FDA-approved products on the Preferred Drug List (PDL) at many pharmacies

Drug Pricing and Pricing Appeals

CareSource is dedicated to working with our PBM, Express Scripts, and our Pharmacy partners to provide the most current National Average Drug Acquisition Cost (NADAC) pricing, as applicable, for drug reimbursement.

NADAC pricing can be accessed on Medicaid.gov. Pricing information can also be accessed through the secure Express Scripts Provider Portal.

Drug Pricing Appeals can be completed through the portal and by following the Express Scripts Appeal Process (if applicable) instructions.

Member Services: 1-833-230-2005 (TDD/TTY: 711) Monday through Friday, 8 a.m. – 5 p.m. CT