Drug Formulary

To see what medicines CareSource covers, you can access our . You also can use the online Find My Prescriptions tool.

We want to make sure our members get the safest, most cost-effective drugs for their needs. We use evidence-based guidelines to make sure our formulary meets best medical practices.

Drug Formulary Changes

Effective each quarter, there will be changes to our Drug Formulary. You can check the Notice of Formulary Changes to see if any of these changes affect the medicines you take.

Quantity Limits

Some drugs have limits on how much can be given to a member at one time. The abbreviation “QL” is used in the Drug Formulary to show there is a quantity limit.

Step Therapy

Members may need to try one drug before taking another. This is called Step Therapy. CareSource will cover certain drugs only if Step Therapy is used. The abbreviation “ST” is used in the Drug Formulary to show when Step Therapy is required.

Generic Substitution and Therapeutic Interchange

A pharmacy may provide a generic drug 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. This is known as therapeutic interchange.

Generic drugs usually cost less than their brand-name equivalents.

In most instances, a brand-name drug for which a generic product becomes available will become non-formulary, with the generic product covered in its place, upon release of the generic product onto the market. However, the formulary document is subject to state-specific regulations and rules regarding generic substitution and mandatory generic rules apply where appropriate.

How to Request a Medicine not on the Formulary

Sometimes a member may have a drug allergy or intolerance. Or, a certain drug may not be effective for a member. In these cases, the member or the member’s representative may ask for an exception to drugs listed on the CareSource Marketplace Drug Formulary. The member or member’s representative can call Member Services to make the request, or complete the online Member Exception Request for Non-Formulary Medication

CareSource then contacts the appropriate health partner. CareSource may ask the health partner to provide written clinical documentation about why the member needs an exception. Health partners must provide this information. As part of the process, CareSource will consider whether the requested drug is clinically appropriate.

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.