Preferred Drug List
CareSource covers all medically necessary Medicaid-covered drugs at many pharmacies. As a CareSource member, you have no copays*. CareSource also covers many commonly used over-the-counter (OTC) medications with a written prescription from your doctor.
CareSource uses a Preferred Drug List also called a PDL. These are drugs that we like our health partners to prescribe. The list does not show all of the drugs covered by Ohio Medicaid. An updated PDL list is also posted every quarter.
You can get your prescription drugs at any pharmacy that takes CareSource. Find a Pharmacy near you. Simply type in your address and follow the prompts. 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 Ohio, be sure to fill your prescriptions before you leave.
For some drugs, we may also 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 drug is needed. We must approve the request before you can get the drug.
Here are some reasons a prior authorization may be needed:
- There is a generic or pharmacy alternative drug available.
- The drug could be misused/abused.
- There are other drugs that should be tried first.
CareSource will review and give a decision within 24 business hours of the original receipt of a pharmacy prior authorization request. Requests we get on weekends and CareSource-designated holidays may take longer than 24 hours.
If it is an emergency, a 72-hour override may be used so that you can get your medicine.
Prior authorization requests for a drug 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 our Preferred Drug List (PDL). You can also see all Drugs That Require Prior Authorization. You can request a drug that is not on our PDL by submitting a Member Request for a Non-Formulary Medication. You can call Member Services to ask about our PDL, prior authorization list or any CareSource services.
Find My Prescriptions
Do you want to look up your medicine and find out if it is covered by CareSource? It’s easy when you use our Find My Prescriptions tool. This tool will help you learn how to find your medicine.
A pharmacy will provide a generic drug if available in place of a brand-name drug. This is called generic substitution. Members and health partners can expect the generic to produce the same effect and have the same safety profile as the brand-name drug.
If a brand-name product is requested when a generic equivalent is available, a prior authorization request will need to be submitted from your health partner.
Sometimes a member might have a drug allergy or intolerance, or a certain drug might not be effective. Your health partner may request a drug that is not on the PDL. This is called therapeutic interchange. Your health partner will then need to submit a prior authorization request.
Some drugs have limits on how much can be given to a member at one time. Quantity limits are based on the drug makers’ recommended dosing frequencies. Patient safety is also considered.
Members may need to try one drug before taking another. This is called step therapy. A member must first try a medicine on the formulary before a drug that is not on the formulary would be approved for use. Certain drugs are covered only if step therapy is used.
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.
*While CareSource covers all medically necessary Medicaid-covered medications, we use a Preferred Drug List (PDL). These are drugs that we prefer your provider prescribe. Typically, our PDL includes more than one drug for treating a particular condition. These different possibilities are called "alternative" drugs. Many alternative drugs are just as effective as other drugs and do not cause more side effects or other health problems.