Pharmacy

CareSource RxInnovations™ has partnered with Express Scripts® to help you manage your prescriptions and save money.

Prescription Drug Benefits

CareSource Dual Advantage plans cover all medically necessary prescription drugs under Medicare Part B; see the Evidence of Coverage on the Plan Documents page for specific details. The plans use a formulary (a list of covered drugs) for drugs covered under Medicare Part D.

Here are some more important facts about the prescription program:

  • You may have copayments for your prescriptions.
  • You have to go to a pharmacy that accepts CareSource Dual Advantage plans to get your prescriptions.
  • Your medication may have certain limitations.
  • The prior authorization requirements for your medicines may change.

To learn more about covered drugs, review our Drug Formulary webpage.

2022 Prescription Drug Coverage

CareSource Dual Advantage™ (HMO D-SNP)

Drug Tiers

30-day retail* (Initial Coverage)

90-day retail* (Initial Coverage)

90-day mail order* (Initial Coverage)

Tier 1
(Preferred Generic)

25% coinsurance or applicable LIS copay

25% coinsurance or applicable LIS copay

25% coinsurance or applicable LIS copay

Tier 2 (Generic)

25% coinsurance or applicable LIS copay

25% coinsurance or applicable LIS copay

25% coinsurance or applicable LIS copay

Tier 3 (Preferred Brand

25% coinsurance or applicable LIS copay

25% coinsurance or applicable LIS copay

25% coinsurance or applicable LIS copay

Tier 4 (Non-Preferred Brand)

25% coinsurance or applicable LIS copay

25% coinsurance or applicable LIS copay

25% coinsurance or applicable LIS copay

Tier 5 (Specialty Tier)

25% coinsurance or applicable LIS copay

Not Covered

Not Covered

Tier 6 (Select Care Drugs)

$0 copay or applicable Low-Income Subsidy (LIS) copay

$0 copay or applicable Low-Income Subsidy (LIS) copay

$0 copay or applicable Low-Income Subsidy (LIS) copay

*Certain medications called specialty medications are limited to no more than a 30 day supply per refill

*Cost-sharing may change depending on the pharmacy you choose, days’ supply and what phase of the Part D benefit you presently are in. For more information on the additional pharmacy specific cost-sharing and the phases of the benefit, call the Member Services phone number on the back of your CareSource member ID card.

Need Help Paying for Your Prescription Drugs?

If you are in a program that helps pay for your drugs (Extra Help), the information about costs for Part D prescription drugs may not apply to you. Please review How to Get Help with Drug Costs to learn about your drug costs if you get Extra Help. Many people are eligible and don’t even know it. To see if you qualify, please follow the instructions in your Evidence of Coverage (Chapter 2, section 7). You can find this document and others on the Plan Documents page.

Low Income Subsidy (LIS) or “Extra Help” Cost Sharing Chart for Initial Coverage Phase

LIS Level

Drug Type

Cost Sharing

FPL Institutionalized

Generic

$0 copay

Brand

$0 copay

FPL < 100%

Generic

$1.35 copay

Brand

$4.00 copay

FPL > 100%

Generic

$3.95 copay

Brand

$9.85 copay

FPL 135 – 149%

Generic

15% coinsurance

Brand

15% coinsurance

*Certain medications called specialty medications are limited to no more than a 30-day supply per refill.

Pharmacies

CareSource features over 1,500 pharmacies in our network:

  • More than 1,500 retail pharmacies
  • More than 50 long-term care pharmacies
  • More than 10 home infusion pharmacies

CareSource has contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area. You may go to any of our network pharmacies. To find a network pharmacy near you, use our Find a Pharmacy search tool and select CareSource Dual Advantage plan from the filter options.

CareSource offers mail-order service for prescription drugs. You can find additional information about this service on the Mail Order Drugs page and in your Evidence of Coverage on the Plan Documents page.

Formulary

The formulary is a list of all drugs covered under your plan. The formulary consists of more than 3,000 medications. CareSource provides monthly formulary updates to keep information current. For the most up-to-date information, you can always access our Find My Prescriptions online search tool

Learn more about the Drug Formulary.

Drug Transition Policy

Under certain circumstances, CareSource can offer a temporary supply of a drug to you when your drug is not on the drug list or when it is restricted in some way. Doing this gives you time to talk with your provider about the change in coverage and figure out what to do.

Learn more about the Drug Transition Policy.

Medication Therapy Management Program

CareSource offers a Medication Therapy Management (MTM) program to ensure your covered Part D drugs are appropriate, to improve your medication use, and to reduce the risk of adverse events like drug interactions. 

Learn more about the MTM program.

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 U.S. Food & Drug Administration website.

Visit the Plan Documents page to view important documents about our plan’s prescription drug benefits.