Pharmacy Policies
These pharmacy policies apply to our Kentucky Medicaid plan.
Some administrative policies conjoin with our pharmacy policies (such as, non-formulary medications, off-label use, drug professional administration, etc.). Click here to review CareSource’s administrative policies.
The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.
Current Pharmacy Policies
A
B
- Benlysta (belimumab)
- Berinert (C1 Esterase Inhibitor (Human))
- Betaseron (interferon beta-1b)
- Bethkis (tobramycin inhalation solution)
- Biologic and other Ophthalmologic Agents
- Biologic Cholesterol Agents
- Botox (onabotulinumtoxinA)
- Brineura (cerliponase alfa)
- Bunavail (buprenorphine and naloxone) buccal film
C
D
E
F
G
H
I
K
L
M
N
O
P
- Palynziq (pegvaliase-pqpz)
- Parenteral Calcium Regulators - pamidronate (Aredia), zoledronic acid (Reclast and Zometa), ibandronate (Boniva), denosumab (Prolia and Xgeva), teriparatide (Forteo)
- Pegasys (peginterferon alfa-2a)
- Pegylated and Non-Pegylated Interferon
- Plegridy (peginterferon beta-1a)
- Probuphine (buprenorphine subdermal implant)
- Procrit (epoetin alfa)
- Promacta (eltrombopag)
- Pulmonary Arterial Hypertension
- Pulmozyme (dornase alfa inhalation solution)
Q
R
S
- Sabril (vigabatrin)
- Saizen (somatropin)
- Serostim (somatropin)
- Siliq (brodalumab)
- Simponi (golimumab)
- Simponi Aria (golimumab)
- Soliris (eculizumab)
- Sovaldi (sofosbuvir)
- Spinraza (nusinersen)
- Spravato (esketamine)
- Stelara (ustekinumab)
- Strensiq (asfotase alfa)
- Sublocade (buprenorphine extended-release) injection, for subcutaneous use
- Suboxone (buprenorphine and naloxone) sublingual film, for sublingual or buccal use
- Subutex (buprenorphine)
- Supartz FX (sodium hyaluronate)
- Symdeko (tezacaftor/ivacaftor)
- Synagis (palivizumab)
- Synvisc (sodium hyaluronate)
- Synvisc-One (sodium hyaluronate)