Preferred Drug List
CareSource uses a Preferred Drug List, also called a PDL. The PDL is a list of the drugs that we prefer your provider prescribe. The list shows the most common, but not all, drugs covered by Ohio Medicaid. Each plan has its own PDL.
CareSource covers all medically necessary Medicaid-covered drugs at many pharmacies. CareSource also covers many commonly used over-the-counter (OTC) medications with a written prescription from your doctor.
As a CareSource member, you have no copays.
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.
Changes to the PDL are also posted every quarter.
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.
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.
- Some drugs require additional information from your provider.
CareSource will review and give a decision within 24 business hours of the original receipt of a pharmacy prior authorization request.
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 the Preferred Drug List (PDL) above. You can also see a list of Drugs That Require Prior Authorization. You can call Member Services to ask about our PDL, prior authorization list or any CareSource services.
How to Request a Medicine Not on the PDL
You can ask for a medicine that is not on our preferred drug list. This is called asking for an exception. To ask for an exception, please fill out this form. When you are done, click “Submit Request.” Our Pharmacy department will look at your request and give you an answer within 72 hours.
A pharmacy will provide a generic drug if available in place of a brand-name drug. This is called generic substitution. Members and health care providers 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 provider.
Sometimes you might have a drug allergy or intolerance, or a certain drug might not be effective. Your health care provider may request a drug that is not on the PDL. This is called therapeutic interchange. Your provider will then need to submit a prior authorization request.
Sometimes, a member must try a medicine on the PDL before a drug that is not on the PDL would be approved by CareSource. This is called step therapy. Certain drugs are covered only if step therapy is used.
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.
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.