...Member Exception Request Form – Use this online form to ask for an exception to a drug listed on the CareSource Marketplace Drug Formulary Internal Appeal Request Form – Use...

...Prior Authorization Request Form (coming soon). Home and Community Based Services (HCBS)/Waiver providers should submit the HCBS/Waiver Provider Prior Authorization Request Form (coming soon). Nonparticipating Providers Prior authorization must be...

...is not on the plan’s formulary. Asking us to waive restriction on the plan’s coverage for a drug (such as limits on the amount of the drug you can get)....

...number are free. Mail: If you would like to file a grievance in writing, complete the Grievance Form and send it to CareSource, P.O. Box 1432, Dayton, OH 45401-1432. When...