Comprehensive Formulary

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The comprehensive formulary is a list of drugs covered under the Part D benefit of your CareSource Dual Advantage plan. CareSource provides monthly formulary updates to keep information current.

For information about changes to our formulary, please review the Notice of Formulary Changes below. For the most up-to-date formulary information, use our online Find My Prescription tool.

Visit the Plan Documents page to view important documents about prescription drug benefits.

Formulary Changes

We feel it is important that you have continued access to the formulary drugs that were available to you when you chose our plan for the coverage year.

Generally, if you are taking a drug on our formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. If these changes occur, no prior notification will be provided before the change is made. 

Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. 

If the FDA finds a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.

Review our Navigate Notice of Formulary Changes (11/30/2023) Last updated on 11/30/2023 for information about updates that have been made to our plan’s formulary.

Why Choose Generics?

CareSource covers both brand-name drugs and generic drugs. Generic drugs have the same active ingredients as brand-name drugs. Generic drugs usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand-name drugs.

You will notice the formulary offers generic substitutions for brand-name drugs when possible. By choosing generics, you will still get effective, safe treatment and you may save money.

Coverage Requirements

For certain prescription drugs, we have additional requirements for coverage or limits on our coverage. This ensures our members use these drugs in a safe way. The types of additional requirements are listed below:

  • Prior Authorization Criteria – For certain drugs, your doctor will need to contact us before you can fill your prescription.
  • Step Therapy Criteria – For certain drugs, we require you to first try another drug to treat your medical condition before we will cover the drug initially prescribed by your physician.

What Are My Options

Can I receive coverage for drugs not on the formulary?

You may ask that we cover a drug not on the formulary by requesting an exception. CareSource will review your request and let you know via mail our decision (coverage determination). If your coverage determination is denied, you can appeal the decision by asking for an appeal or redetermination of the original request.

Full details on coverage determinations and appeals can be found in the Evidence of Coverage (Chapter 9, section 6). Find this and other documents on our Plan Documents page. For more information about exceptions, appeals and complaints review your Part D Prescription Drug Plan Rights.

What if I am taking a drug not on the formulary? 

CareSource Dual Advantage plan includes a drug transition policy. Learn more by visiting our Drug Transition Policy webpage.

What if I need help managing my medications?

Medication Therapy Management (MTM) is a service we offer at no cost. MTM is designed to help you learn about your medications, prevent or address medication-related problems, decrease costs and stick to your treatment plan. Learn more about MTM.

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