Preferred Drug List

CareSource pays for all medically necessary prescription drugs on our Preferred Drug List (PDL) at many pharmacies. These are drugs we prefer your provider to prescribe. Our drug list has more than one drug for treating a health issue. These options are called alternative drugs. Alternative drugs are just as good as other drugs with similar side effects. CareSource also covers many commonly used over-the-counter (OTC) medications with a written prescription from your provider. If there are any changes to the PDL, they are posted below each quarter.

Preferred Drug Lists

Find My Prescriptions

Do you want to look up your medicine and find out if it is covered by CareSource? It’s easy when you use our Find My Prescriptions tool. This tool will help you learn how to find your medicine.

Prior Authorization

CareSource may need to review some drugs before they will be covered. This is called a Navigate prior authorization. Your provider will contact us and explain why you need a certain drug and/or a certain amount of a drug. We must approve the request before it will be covered. Learn more about prior Navigate authorization requirements for medications.

Here are some reasons a prior authorization may be needed:

  • The drug could have dangerous side effects.
  • There is a generic or preferred alternative drug available.
  • The drug could be misused/abused.
  • There are other drugs that should be tried first.

CareSource will review and give a decision within 24 hours of the original receipt of a pharmacy prior authorization request unless additional information is required from your doctor. In an emergency, your pharmacy may override a prior authorization requirement for 72 hours so that you can get your medicine in the meantime.

Prior authorization requests for a drug may be denied. If the request is denied, we will send you information explaining our decision, and what your options are. You can see on the PDL above which drugs require a prior authorization. You can call Member Services to ask about our PDL and which drugs or services require a prior authorization.

How to Request a Medicine Not on the PDL

You can ask us to cover a medicine that is not on our preferred drug list. This is called asking for an exception. To ask for an exception, please fill out this form. When you are done, click “Submit Request.” Our Pharmacy department will look at your request and give you an answer within 24 hours unless additional information is required from your doctor.

Generic Substitution

A drugstore 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 if they ask for a brand name drug when there is a generic drug available.

Therapeutic Interchange

Sometimes you can’t take a certain drug, like if you have an allergy. Other times, a drug might not work for you. In these cases, your provider can ask CareSource to cover a drug that is not on the approved drug list.

Step Therapy

Sometimes, CareSource requires that you try a less expensive medicine used for the same condition before “stepping up” to a medication that costs more. This is called step therapy. Certain drugs may only be covered if step therapy is used.

Quantity Limits

Some drugs have limits on how much can be given to a member at one time. Quantity limits may be based on several factors such as the drug makers’ recommended dosing, patient safety, or the Food & Drug Administration (FDA) recommendations.

Drug Safety Recalls

Sometimes, a drug manufacturer or 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.

Member Services: 1-855-202-0729 (TTY: 1-800-255-0056 or 711), Monday – Friday 7 a.m. – 7 p.m.