...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...

...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...

...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...

...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...

...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...

...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...

...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,...

...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...

...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...

...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...