Prescription Drug Coverage
Looking for 2023 Benefit Information?
CareSource RxInnovations™ has partnered with Express Scripts®, our Pharmacy Benefit Manager (PBM). A PBM helps health plans manage prescriptions.
Prescription Drug Benefits
CareSource Dual Advantage plans cover medications under Medicare Part D that help you stay healthy; see the Evidence of Coverage on the Plan Documents page for specific details. The plans uses a Comprehensive Formulary (a list of covered drugs approved by Medicare).
Here are some more important facts about the prescription program:
- $0 copay on all prescriptions when you qualify for Extra Help.
- Save a trip and get your medications delivered directly to you – mail order available at no extra cost for many of your prescriptions.
- Up to 102-day supply prescriptions and dose packs for many drugs by mail or at retail pharmacies that you already use.
- You have to go to a pharmacy that accepts CareSource Dual Advantage to get your prescriptions.
- Your medication may have certain limitations. This may include requiring a prior authorization, step therapy, or quantity limit.
- The prior authorization requirements for your medicines may change.
CareSource Dual Advantage™ (HMO D-SNP)
You have no copays for prescription drugs if you receive Extra Help.
Tiers are groups of drugs on our Drug List.
- Tier 1: Preferred Generic drugs have a $0 copay
- Tier 2: Generic drugs have a $0 copay
- Tier 3: Preferred Brand drugs have a $0 copay
- Tier 4: Non-Preferred drugs have a $0 copay
- Tier 5: Generic and Brand Specialty drugs have a $0 copay
If you have questions, call us at 1-833-230-2020 (TTY: 1-833-711-4711 or 711). We are open 8 a.m. to 8 p.m. Monday through Friday, and from October 1 through March 31 we are open the same hours, seven days a week.
2023 Prescription Drug Coverage
CareSource Dual Advantage™ (HMO D-SNP)
| Drug Tiers | 30-Day Retail* (Initial Coverage) | 90-Day Retail* (Initial Coverage) | 90-Day Mail Order* (Initial Coverage) |
|---|---|---|---|
| Tier 1 (Preferred Generic) | $0 copay | $0 copay | $0 copay |
| Tier 2 (Generic) | 25% coinsurance or applicable Extra Help | 25% coinsurance or applicable Extra Help | 25% coinsurance or applicable Extra Help |
| Tier 3 (Preferred) | 25% coinsurance or applicable Extra Help | 25% coinsurance or applicable Extra Help | 25% coinsurance or applicable Extra Help |
| Tier 4 (Non-Preferred) | 25% coinsurance or applicable Extra Help | 25% coinsurance or applicable Extra Help | 25% coinsurance or applicable Extra Help |
| Tier 5 (Specialty Tier) | 25% coinsurance or applicable Extra Help | Not Covered | Not Covered |
See Chapter 6 of your Evidence of Coverage on the Plan Documents page for specific details.
*Certain medications called specialty medications are limited to no more than a 30 day supply per refill
*Cost-sharing amounts may change depending on the pharmacy you choose, days’ supply, what phase of the drug benefit you are in and your level of Extra Help. For more information on the additional pharmacy specific cost-sharing and the phases of the benefit, call the Member Services phone number on the back of your CareSource member ID card.