Preferred Drug List

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. Our PDL has more than one drug for treating a condition. These options are called alternative drugs. Alternative drugs are just as effective as other drugs with similar side effects. If there are any changes to the PDL, we will post them.

Step Therapy

In some cases, you may need to try one drug before taking another. This is called Step Therapy. A member may need to try a medicine on the PDL before a drug that is not on the PDL would be approved by CareSource PASSE. Certain drugs will be covered only if Step Therapy is used.

Generic Substitution

A pharmacy will give you a generic drug in place of a brand-name drug. Generic drugs have the same effect and safety as brand-name drugs. Your provider will need approval from CareSource PASSE if they ask for a brand-name drug when there is a generic drug available, unless the brand is cited as preferred. 

Exceptions

You may ask us to cover a drug not on the PDL. This is called an exception. You may ask for an exception because of an allergy, not being able to take a drug, or a poor response to a PDL drug. You or a person allowed to represent you can give this request. Once we get this request, we will work with your provider to get the forms and information needed.

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