Pharmacy

This benefit provides coverage for prescriptions obtained from a retail pharmacy, mail-order pharmacy or specialty pharmacy, as well as those that are administered in the patient’s home, including drugs administered through a home health agency.

CareSource uses evidence-based guidelines to ensure health care services and medications meet the standards of excellent medical practice and are the lowest cost alternative for the member. 

Restrictions & Limits

Some covered drugs may have additional requirements or limits on coverage including prior authorization, step therapy or quantity limits.

Pharmaceutical Management Materials

To learn more about how to use our pharmaceutical management procedures, look in the summary section of the formulary. CareSource provides pharmaceutical management procedures annually and after updates. Changes are made in writing by mail, fax or email or via the web.

Contact Information for Coverage Decisions

Mail: Express Scripts
P.O. Box 66571
St. Louis, MO 63166-6571
Attn: Medicare Reviews

Phone: 1-800-935-6103

Hours of operation are 24 hours a day, seven days a week, 365 days a year.

Fax: 1-877-251-5896