Pharmacy

CareSource helps you pay for your prescription drugs and some prescription medical supplies at the pharmacy. You can get your prescriptions at any pharmacy that is in-network with CareSource. Use the Find a Pharmacy Quick Link on the left side of the page to find a pharmacy near you.

Here are some more important facts about CareSource prescription drug coverage:

  • You have to go to a pharmacy that takes CareSource to get your prescriptions.
  • You will need to show your ID card and your prescription at the pharmacy. Your ID card will let pharmacies know you are a CareSource member.
  • You may have copayments, a deductible, and/or coinsurance for your prescriptions, depending on your plan.
  • Some medicines may have limits on how much can be dispensed to you at one time.
  • Some medicines may require you try another medicine first before CareSource will cover it.
  • Some medicines require permission or prior authorization in order for it to be covered by your plan. The health partner who orders the drug should help you get a prior authorization. The prior authorization requirements for your medicines may change.

Covered Prescriptions 

CareSource uses a formulary, also called the CareSource Marketplace Drug Formulary. These are drugs that we like our providers to prescribe. Use our Find My Prescriptions tool to search for your prescriptions to find out what medicines are covered and at what amounts for your plan. You can also find the formulary document located on the Drug Formulary page, along with useful information such as how to request a drug not on our Drug Formulary.

Prescription Costs

Using our Find My Prescriptions tool is a quick way to confirm your prescriptions costs. Drugs on the CareSource formulary are placed in six different levels or tiers. Each tier has a different cost-sharing amount. It is important to note that because of frequent changes in the price of medications, the prescription costs in the Find My Prescriptions tool may not be exact.

Some out-of-state pharmacies do not take CareSource, but most chain drug stores across the country do. If you think you will travel out of our service area, be sure to fill your prescriptions before you leave. You can also use our Find a Pharmacy tool to confirm if there is a pharmacy in your area.

Specialty Pharmacy

CareSource works with CVS Caremark to supply specialty medications that your doctor may prescribe. Specialty drugs might be ordered when you have a chronic or difficult health condition. They typically require special handling or monitoring, or special administration. If you have been prescribed specialty drugs, CVS Caremark can:

  • Help you get your prescription filled or moved from the pharmacy you get it from now
  • Deliver your specialty meds to your home, workplace or to your doctor’s office
  • Help you learn about your specialty medication and give you support from specially-trained health care professionals

For more information, call CaremarkConnect® at 1-800-237-2767. They can take your call Monday through Friday from 7:30 a.m. to 9 p.m. Eastern Standard Time (EST).

You may also access the Caremark.com website in order to manage prescription refills for existing specialty mail order medications as well as check coverage information.

Prior Authorization

For some drugs, we require that your doctor send us some information. This is called a prior authorization request. It tells us why a certain drug and/or a certain amount of a drug is needed. We must approve the request before you can get the drug covered by your plan.

You can find out if a drug requires prior authorization by reviewing the CareSource Marketplace Drug Formulary on the Drug Formulary page. Medications billed on the medical benefit may also require prior authorization. Please check the NavigateAuthorization Requirements for Medications on the Medical Benefit.

We may not approve a prior authorization request for a drug. If we don’t, we will send you information about how you can appeal our decision.

Opioid drugs must meet the following prior authorization requirements:

  • Less than 90 days of therapy in the last 365 days
  • Less than 90 morphine milligram equivalents per day
  • No concurrent therapy with benzodiazepines
  • All extended release opioids require prior authorization

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.


DISCLAIMERS

CareSource is a Qualified Health Plan issuer in the Health Insurance Marketplace. This is not a Health Insurance Marketplace website. This website does not display all available Marketplace plans. To see all available Qualified Health Plan options available, go to www.healthcare.gov.

This website is subject to change at any time without prior notice. This website is intended only as general information and is not an offer or invitation to contract.

This is a solicitation for health insurance. CareSource Marketplace plans have exclusions, limitations, reductions and terms under which the policy may be continued in force or discontinued. Premiums, deductibles, coinsurance and copays may vary based upon individual circumstances and plan selection. Benefits and costs vary based upon plan selection. Not all plans and products offered by CareSource cover the same services and benefits. Covered services and benefits may vary for each plan. For costs and complete details of coverage, please review CareSource’s Evidence of Coverages and Schedules of Benefits documents at www.caresource.com/marketplace.

Specific policy benefits listed on this website are intended to be a summary of coverage and do not list or describe all the benefits covered under specific policies nor is every limitation, exclusion or reduction of benefits listed. The overview of benefits, coverage and member cost shares are based on benefits being received from an in-network provider. To be eligible for reimbursement, all health care services must be provided by an in-network provider, except when applicable federal and state law or the applicable Evidence of Coverage for each policy provide otherwise.

Rates, benefits, premiums, deductibles, co-payments, co-insurance, and out of pocket expenses may vary based upon a variety of factors, including but not limited to, age, county of residence, smoking status, and level of policy selected.

References to CareSource pertain to each individual company or other CareSource affiliated companies, such as CareSource, CareSource Kentucky Co., CareSource Indiana Inc., CareSource West Virginia Co., and CareSource Georgia, Co. Each company is a separate entity and is not responsible for another’s financial condition or contractual obligations.

CareSource does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

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Last updated 10/23/2019