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West Virginia
West Virginia

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 takes 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 the prescription program:

  • 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 for your prescriptions.
  • Some medicines may have limits on how much can be dispensed to you at one time.
  • Some medicines require permission or prior authorization. The health partner who orders the drug should help you get prior authorization. The prior authorization requirements for your medicines may change.

Covered Prescriptions

CareSource uses a formulary or preferred drug list, also called a PDL. These are drugs that we like our providers to prescribe. Click on the Find My Prescriptions Quick Link to see what medicines and medical supplies are covered. You can also find the PDL located on the Drug Formulary page along with useful information like how to request a drug not on our PDL. 

PRESCRIPTION COSTS

Drugs on the CareSource formulary are placed in six different levels or tiers. Each tier has a different cost-sharing amount. The amount you pay for a drug on Tiers 1-4 is considered a copay and counts toward your maximum out-of-pocket costs. Drugs on Tier 5 are specialty preferred and non-preferred with coinsurance. This coinsurance also counts toward your maximum out-of-pocket costs.

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.

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.

You can find out if a drug requires prior authorization by reviewing the PDL 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.

CareSource will review the request and give a decision within 24 hours of the original receipt of the pharmacy prior authorization request, if received before 5 p.m. on Friday. Requests we get on weekends and CareSource-designated holidays may take longer than 24 hours.

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.

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.