Preferred Drug List

CareSource pays for all medically necessary prescription drugs on our Preferred Drug List (PDL) at many pharmacies. These are drugs we prefer your provider to prescribe. Our drug list has more than one drug for treating a health issue. These options are called alternative drugs. Alternative drugs are just as good as other drugs with similar side effects. CareSource also covers many commonly used over-the-counter (OTC) medications with a written prescription from your provider. If there are any changes to the PDL, they are posted below each quarter.

We also have a NavigateList of Covered Vaccines to help you determine if a vaccine is covered at your provider’s office or your local participating pharmacy, and if there are any requirements for coverage.

Preferred Drug List

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.

Prior Authorization

CareSource may need to review some drugs before they will be covered. This is called a prior authorization. Your provider will contact us and explain why you need a certain drug and/or a certain amount of a drug. We must approve the request before it will be covered. NavigateLearn about authorization requirement for medications here.

Here are some reasons a prior authorization may be needed:

  • The drug could have dangerous side effects.
  • There is a generic or preferred 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 hours of receiving the prior authorization request> unless we need more information from your provider. In an emergency, your pharmacy may override a prior authorization requirement for 72 hours so that you can get your medicine.

Prior authorization requests for a drug may be denied. If the request is denied, we will send you information explaining our decision, and what your options are. You can see on the NavigatePreferred Drug List (PDL) which drugs require a prior authorization. You can also call Member Services to ask about our PDL, and which drugs or services require a prior authorization.

How to Request a Medicine Not on the PDL

You can ask us to cover a medicine that is not on our preferred drug list. Just fill out the exception form. Our Pharmacy team will give you an answer <within 24 hours> unless we need more information from your provider.

Member Services: 1-800-488-0134 (TTY: 1-800-750-0750 or 711), Monday – Friday 7 a.m. – 7 p.m.