Prescription Drugs
With CareSource, you will have access to all of the CBI-covered prescription drugs your child needs. We provide access to more than 52,000 pharmacies.
CareSource uses a formulary to show the drugs we prefer that your doctor prescribe. Some drugs are not covered by the CBI program. Some drugs may also have amount limits.
CareSource will coordinate your child's medical care and prescription drug needs so you can focus on other things for your family.
We know you probably have a lot of questions about CBI prescription drug benefits. Here are some questions we are often asked:
How do I find a pharmacy?
For the most recent listing, click on Find a Pharmacy to find a pharmacy location near you. Just type in your address and the system will tell you the network pharmacy locations near your home.
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What is a network pharmacy?
We call the pharmacies listed in our pharmacy directory our "network pharmacies" because we have agreements with them to provide prescription drugs to our members. A network pharmacy is a pharmacy where members can get prescription drug benefits provided by CareSource.
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What if I have to use an out-of-network pharmacy?
In most cases, your prescriptions are covered under CareSource only if they are filled at a network pharmacy. CareSource will allow three out of network fills per drug per calendar year. Out-of-network pharmacy use beyond the three fills only applies in an emergency. If you continue to go to an out-of-network pharmacy, you may have to pay the full cost (rather than paying just your co-payment) when you fill your prescription.
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Are the doctors in your network aware of your prescription drug benefits?
Yes, participating CareSource physicians have been notified in writing of the drugs included on the formulary as well as the special procedures set up for urgent medication requests.
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How do I find out if my child's drug is covered?
You may view our formulary by clicking here, or you can call our Member Services Department at 1-866-415-0584, Monday - Friday, 7 a.m. - 7 p.m. TTY users should call 1-800-750-0750 or 711. Some drugs may have quantity limits and may require a prior authorization.
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Does CareSource require prior authorization?
If your doctor feels it is medically necessary for your child to have a drug that is not on the list, he or she will need to ask for a prior authorization. Some drugs may have quantity limits and may also require a prior authorization. Quantity limits can be found on the formulary.
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Does CareSource offer generic drugs?
CareSource covers both brand name drugs and most generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
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Will the formulary change?
Yes, please check this web site for updates as the formulary may change from month to month.
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Will I have co-pays for my child's prescription drugs? If so, how much will it be?
Yes. Co-pays may vary by drug. The grid below provides guidelines for how much the prescription drug co-pays will be for your child's medication.
| Most generic drugs |
Preferred drugs |
All other drugs |
| $10 |
$22 |
$44 |
Click here to view the formulary.
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What happens if my child's medication is lost or stolen?
CareSource will cover lost or stolen medication one time per year and co-pays will apply.
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What if I don't agree with a decision made about my child's prescription drug benefits?
You can file a grievance. A grievance is a complaint that shows you are not satisfied with the plan or pharmacy's service. To find out how to file a grievance, please call our Member Services Department at 1-866-415-0584, Monday - Friday, 7 a.m. - 7 p.m. TTY users should call 1-800-750-0750 or 711.
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If you have more questions about the CBI prescription drug benefits, please click on the tell us link to send us your question(s).