Humana – CareSource® will pay for your medically-necessary prescription drugs and some prescription medical supplies at the pharmacy. You will need to get your prescription drugs at a pharmacy that takes Humana – CareSource. Let Find a Pharmacy find a Humana – CareSource pharmacy near you.*
Please show your ID card with your prescription to the pharmacy. Your ID card will let pharmacies know that Humana – CareSource pays for your medicines. The pharmacy and prescriber must be registered with KDMS for the prescription to be covered.
Here are some more important facts about the prescription program:
- You have to go to a pharmacy that takes Humana – CareSource to get your prescriptions.
- The prior authorization requirements for your medicines may change.
*If you needed help managing your health care needs and were identified for the Kentucky Lock-In Program (KLIP), a pharmacy was chosen for you. Refer to the KY Lock-In Program web page. You may also refer to your member handbook (English or Spanish… Coming soon).
Humana – CareSource uses a formulary or preferred drug list, also called a PDL.** These are drugs that we like our providers to prescribe. Click on the Find My Prescriptions link to see what medicines and medical supplies are covered. You can also find the PDL located on the Preferred Drug List page along with useful information like how to request a drug not on our PDL.
** While Humana – CareSource covers all medically necessary Medicaid-covered medications, we use a preferred drug list (PDL). These are drugs that we prefer your provider prescribe. Typically, our PDL includes more than one drug for treating a particular condition. These different possibilities are called “alternative” drugs. Many alternative drugs are just as effective as other drugs and do not cause more side effects or other health problems.
Humana – CareSource uses CVS Specialty Pharmacy to supply specialty medications your doctor may prescribe. CVS Specialty Pharmacy can:
- Help you get your prescription filled or moved from the pharmacy you get it from now
- Deliver your specialty meds to your home, workplace or to your doctor’s office
- Help you learn about your specialty medication and give you support from specially-trained health care professionals
- Set up a visit from a nurse for those medications that need one
For more information, call CVS Specialty Pharmacy at 1-800-237-2767. They can take your call Monday through Friday from 7:30 a.m. to 9:00 p.m. Eastern Standard Time (EST).
You may also access the CVS Specialty Pharmacy website to manage prescription refills for existing specialty medications filled at the CVS Specialty Pharmacy as well as check coverage information:
Do you have general questions about specialty pharmacy? Call the Member Services Department at 1-855-852-7005 (TTY: 1-800-648-6056 or 711). We are available 7:00 a.m. to 7:00 p.m. Eastern Time, Monday through Friday.
For some drugs, we may require that your doctor send us some information. This is called a prior authorization request. It tells us why a certain drug and/or a certain amount of drug is needed. We must approve the request before you can get the drug.
Here are some reasons why a prior authorization may be needed:
- There is a generic or pharmacy alternative drug available.
- The drug could be misused/abused.
- There are other drugs that should be tried first.
Humana – CareSource will review a request and give a decision within 24 business hours of the original receipt of a pharmacy prior authorization request. Requests we get on weekends and holidays may take longer than 24 hours.
If it is an emergency, a 72-hour override may be used so that you can get your medicine.
Prior authorization requests for a drug may not get approved. If not approved, we will send you information on how you can appeal our decision and your right to a state hearing.
Generic Substitution and Therapeutic Interchange
A pharmacy will provide a generic drug if available in place of a brand-name drug. This is called generic substitution. Members and health partners can expect the generic to produce the same effect and have the same safety profile as the brand-name drug. If a brand name product is requested when a generic equivalent is available, a prior authorization request will need to be submitted from your provider.
Sometimes a member might have a drug allergy or intolerance, or a certain drug might not be effective and a non-formulary agent is requested. The provider will then need to submit a prior authorization request. This is called therapeutic interchange.
Some drugs have limits on how much can be given to a member at one time. Quantity limits are based on the drug makers’ recommended dosing frequencies. Patient safety is also considered.
Members may need to try one drug before taking another. This is called step therapy. A member must first try a medicine on the formulary before a drug that is not on the formulary would be approved for use. Certain drugs will be covered only if step therapy is used.
Drug Safety Recalls
Sometimes, the federal government issues drug recalls. To find out if a drug you take is being recalled, please check the listings on the FDA website