...Routine care like screenings and exams. You get this care to help stop a health problem from occurring. Prior Authorization Approval that may be needed before you get a service....

...will not be covered. If you have a drug that requires pre-authorization and you would like to use mail orders, our mail order pharmacy will call your provider. If your...

...Most specialty drugs need a prior authorization (PA) before you can get them. Some drugs have limits on how much can be given at once. Talk with your provider about...

...on 12/01/2025 Prior Authorization Criteria – For certain drugs, your doctor will need to contact us before you can fill your prescription. 2025 Prior Authorization Criteria Last updated on 12/01/2025...

...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...

...Prior Authorizations Some prescriptions may need a prior authorization. This means that it will need to be reviewed and approved by us before you can fill it. Your provider will...

...Drug Class within this document. Note: CareSource PA Forms are available on the Forms page under Pharmacy Prior Authorizations. CareSource will continue to maintain and post a Preferred Drug List...

...the Center for Medicare & Medicaid Services (CMS)-issued Children’s Health Insurance Program Reauthorization Act (CHIPRA) Core Set and the Adult Core Set of Quality Measures technical specifications along with the...

...not pay for a covered service performed by the provider unless CareSource PASSE denies prior authorization of the service and the provider notifies the member in writing that the member...

...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...