Preferred Drug List
The Preferred Drug list (PDL) is a list of the medications that we prefer your provider prescribe. The list shows the most common medications covered by your plan. Changes to the PDL are also posted every quarter.
Humana – CareSource also covers many commonly used over-the-counter (OTC) medications with a written prescription from your doctor.
Changes to the Preferred Drug List (PDL)
Each of our plans has its own Preferred Drug List (PDL). This page is used to post changes to the PDL on a regular basis.
Find My Prescriptions
Do you want to look up your medicine and find out if it is covered by Humana – CareSource? It’s easy when you use our Find My Prescriptions tool. This tool will help you find out if certain medications are covered by Humana-CareSource.
For some medications, we may also require that your doctor send us some information. This is called a prior authorization request. It tells us why a certain medication and/or a certain amount of that medication is needed. We must approve the request before you can get it.
Here are some reasons a prior authorization may be needed:
- There is a generic or alternative medication available.
- The medication could be misused or abused.
- There are other medications that should be tried first.
Humana – CareSource will review and communicate with the requesting provider. They will give a decision within 24 hours of the original receipt of a pharmacy prior authorization request.
If it is an emergency, a 72-hour override may be used so that you can get your medicine.
Prior authorization requests for a medication may not get approved. If not approved, we will send you information on how you can appeal our decision and your right to a state hearing.
You can see the Preferred Drug List (PDL) above. You can also see a list of medications that require Prior Authorization below. You can call Member Services to ask about our PDL, prior authorization list or any Humana – CareSource services.
Medications that Require Prior Authorization How to Request a Medicine Not on the PDL
You can ask for 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.
A pharmacy will provide a generic medication if available in place of a brand name medication. This is called generic substitution. Members and health care providers can expect the generic to produce the same effect and have the same safety profile as the brand name medication.
If a brand name product is requested when a generic equivalent is available, a prior authorization request will need to be submitted from your provider.
Sometimes you might have a medication allergy or intolerance, or a certain medication might not be effective. Your health care provider may request a medication that is not on the PDL. This is called therapeutic interchange. Your provider will then need to submit a prior authorization request.
Sometimes, a member must try a medicine on the PDL before a medication that is not on the PDL would be approved by Humana – CareSource. This is called step therapy. Certain medications are covered only if step therapy is used.
Some medications have limits on how much can be given to a member at one time. Quantity limits are based on the medication makers’ recommended dosing frequencies. Patient safety is also considered.
Medication Safety Recalls
Sometimes, the federal government issues medication recalls. To find out if a drug you take is being recalled, please check the listings on the U.S. Food & Drug Administration website.