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Pharmacy
https://www.caresource.com/plans/mich/benefits-services/pharmacy/...initially prescribed. 2026 Step Therapy Criteria Prior Authorization Criteria For certain drugs, your prescriber will need to contact us before you can fill your prescription. Prior Authorization Criteria Visit the...
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COVID-19 Information and Resources
https://www.caresource.com/members/tools-resources/covid19/...Medical equipment Having medical supplies like breathing equipment and others, delivered to your home. Quantity limits and prior authorizations are waived. This includes: medical supplies such as diabetic supplies, incontinence...
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Grievance and Appeal
https://www.caresource.com/members/tools-resources/grievance-appeal/...know. In order for CareSource to talk to your authorized representative, you and your authorized representative must complete the HIPAA Authorization Form and send it to us via fax or...
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Pharmacy
https://www.caresource.com/plans/mycare/benefits-services/pharmacy/...care provider (PCP) to order for you. Some drugs require prior authorization or are not covered by Medicare. Some drugs may also have quantity limits, and some drugs may require...
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Drug Formulary
https://www.caresource.com/benefits-services__trashed/pharmacy/drug-formulary/...formulary If prior authorization, quantity limits and/or step therapy restrictions are added for a drug If a drug is moved to a higher cost-sharing tier If the FDA deems a...
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Part D Prescription Plan Rights
https://www.caresource.com/members/tools-resources/grievance-appeal/part-d-prescription-plan-rights/...benefits on a certain drug, you can request a coverage determination. If your prescription requires approval (prior authorization) prior to being filled, you will get a written notice explaining how...
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Drug Transition Policy
https://www.caresource.com/plans/dsnp/pharmacy/drug-transition-policy/...in the first 90 days of your membership and your medication is not on our covered drug list (formulary) or coverage is limited in some way, such as prior authorization,...
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Prescription Drug Coverage
https://www.caresource.com/plans/dsnp/pharmacy/drug-coverage/...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...
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Plan Documents
https://www.caresource.com/plans/marketplace/plan-documents/...key services — such as Primary Care and some Prescription Drugs — prior to having to satisfy your deductible. If you don’t expect to have many doctor appointments or need...
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Update Practice Information
https://www.caresource.com/providers/provider-portal/update-practice-information/...learn more about CareSource PASSE’s collaboration with BetterDoctor, view the BetterDoctor FAQs. Up-to-date contact information is critical to process your claims and prior authorization requests. In addition, it ensures our...
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Prior authorization