Pharmacy

Humana – CareSource provides your prescription medications and some prescription medical supplies at the pharmacy. Some examples are diabetic supplies, inhaler spacers, peak flow meters, syringes, needles, alcohol wipes and condoms. You will need to get your prescription medications at a pharmacy that takes Humana – CareSource.

Find a Pharmacy near you.* Simply type in your address and follow the prompts. Most out-of-state pharmacies do not take Humana – CareSource, but most chain drug stores across the country do. The pharmacy and prescriber must be registered with the Kentucky Department for Medicaid Services (KDMS) for the prescription to be covered.

If you think you will travel out of state, be sure to fill your prescriptions before you leave.

Please show your ID card with your prescription to the pharmacy. Your ID card will let pharmacies know that Humana – CareSource provides your prescription medications.

Here are some more important facts about the prescription program:

  • You have to go to a pharmacy that takes Humana – CareSource to get your prescriptions.
  • The prior authorization requirements for your prescriptions may change.

*If you need help managing your health care needs and were identified for the Kentucky Lock-In Program (KLIP), a pharmacy was chosen for you. Refer to the Kentucky Lock-In Program web page. You may also refer to your member handbook (English and Spanish).

Covered Prescriptions

Humana – CareSource uses a formulary or preferred drug list, also called a PDL. While Humana – CareSource covers all medically necessary Medicaid-covered medications, those listed on the PDL are ones that we prefer your provider prescribe. Typically, our PDL includes more than one medication for treating a particular condition. These different possibilities are called “alternative” medications. Many alternative medications are just as effective as other medications and do not cause more side effects or other health problems. Click on the Find My Prescriptions link to see what medicines and medical supplies are covered. You can also find the PDL located on the Preferred Drug List page.

Specialty Pharmacy

Humana – CareSource uses CVS Specialty Pharmacy to supply specialty medications your doctor may prescribe. CVS Caremark can:

  • Help you get your prescription filled or moved from the pharmacy you get it from now
  • Deliver your specialty medications 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
  • Set up a visit from a nurse for those medications that need one
  • Help you learn about your medication and any potential drug interactions

Most specialty drugs require a prior authorization before you get your medication. Contact your doctor for more information.

For more information, call CVS Specialty Pharmacy at 1-800-237-2767. They can take your call Monday through Friday from 7:30 a.m. to 9 p.m. Eastern Time.

You may also access the CVS Specialty Pharmacy website to manage prescription refills for existing specialty mail order medications as well as check coverage information. You can still get your non-specialty medications through your local pharmacy.

Do you have general questions about specialty pharmacy? Call Member Services at the number below.

Benefits & Services

What’s changing?

As our member we want to ensure you are aware of any changes that may impact your health insurance. The Commonwealth of Kentucky has issued new guidance on copayments. Based upon this guidance, copayment amounts for certain pharmacy services have changed.

You will not be required to pay more than five percent of your household’s income in a quarter. Also, Medicaid and KCHIP members younger than 19 years of age will not be charged a copayment. Other exemptions may apply. Refer to the copayment grid in the section called “What is a copayment?” for the service or item that you are required to pay as your share of the cost for your prescriptions.

What is a copayment?

A copayment is an amount you are required to pay as your share of the cost for a medical service like a doctor’s visit or a prescription. Pharmacy benefits that require a copayment are:

BenefitCopayment Amount
A Medicaid or KCHIP beneficiary who is younger than nineteen (19) years of age.$0
Brand name drug$4
Generic drug$1
Brand name drug preferred over generic drug$1
Pharmacy product class: certain antipsychotic drug$1
Pharmacy product class: contraceptives for family planning$0
Pharmacy product class: tobacco cessation$0
Pharmacy product class: diabetes supplies, blood glucose meters$0
Pharmacy product class: Diabetes supplies, all other covered diabetic supplies$4 for first fill, $0 for second fill and beyond, per day
Pharmacy patient attribute: pregnant$0
Pharmacy patient attribute: long-term care resident$0
Pharmacy patient attribute: under eighteen (18) years of age, and not a KCHIP beneficiary.$0

Exemptions may apply but are not limited to:

Foster children, preventive services, pregnant women, terminally ill and hospice care, emergency services, and some family planning services.

Member Services: 1-855-852-7005 (TTY: 1-800-648-6056 or 711). We are available 7 a.m. to 7 p.m. EST, Monday through Friday.