...A decision we make about the payment for a Part D drug or an exception to our formulary. Organization Determination – A decision we make about covering a medical service...

...90 days of your membership and your medication is not on your new plan’s covered drug list (formulary) or coverage is limited in some way, such as prior authorization, step...

...Summary of Formulary Changes Effective April 1, 2024 03/01/2024 Summary of PDL Changes Effective March 15, 2024 02/15/2023 Summary of PDL Changes Effective January 1, 2024 12/01/2023 Summary of PDL...

...quit using tobacco products, except when medically contraindicated. For more information on medication assisted treatment for tobacco use, view the Medicaid Drug Formulary. CareSource Provider Fliers Tobacco Cessation Rewards Flier...

...limitations. This may include requiring a prior authorization, step therapy, or quantity limit. The prior authorization requirements for your medicines may change. Questions? Call Member Services. The comprehensive formulary, pharmacy...

...plan covers, how much you pay, and more. Summary of Benefits: Summary of key features about your plan like covered benefits and coverage. Comprehensive Formulary: A list of all drugs...

To have your health care services covered by your CareSource plan, you must get them from a network provider. The only exceptions are: In cases of emergency; If you need...

...of your membership and your medication is not on your new plan’s covered drug list (formulary) or coverage is limited in some way, such as prior authorization, step therapy, or...

Quick References COVID-19 information Pharmacy information, including our Preferred Drug Lists (PDLs) Medical, pharmacy, reimbursement and administrative policies We strive to make partnering with us simple. We’re aware things may...

...week. The comprehensive formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary. Return to the Pharmacy Overview CareSource uses Express Scripts (ESI)...