Pharmacy

CareSource covers all medically necessary  Medicaid-covered medications. We use a Preferred Drug List (PDL). These are the drugs we  would like your provider to choose.

CareSource has drug procedures in place to give you the drugs you need safely. The list of drugs can change. Check the list when you need to fill or refill a drug.

Be sure to bring your CareSource ID card to the pharmacy.  Be sure to fill your prescriptions before you  travel out of state.

Preferred Drug Lists

• Navigate Georgia Medicaid and PeachCare for Kids®
• Navigate Planning for Healthy Babies® (P4HB) Family Planning
• Navigate P4HB Inter-Pregnancy Care (IPC)
• Navigate OTC PDL

Need to know if your medicine is covered? Use our Find My Prescriptions tool.

Prior Authorization

We may ask your provider why you need a certain medicine or dose. A Navigate Prior Authorization (PA) may be needed if:

  • There is a generic or other
  • The drug can be misused.
  • There are other drugs that must be tried

Your provider will contact us. They will tell us why you need a certain drug. We must approve the request before it will be covered.

Some drugs have limits on how much can be given at once. Some drugs are never covered, like drugs for weight loss. If we do not approve a drug, we will tell you. We will let you know the appeal steps, and your right to a state fair hearing.

Learn more about PA requirements for medications.

CareSource will review and give a decision within 24 hours after we get it. If we need more details from your doctor, it may take longer. In an emergency, your pharmacy may override a PA for 72 hours.

PA requests for a drug may be denied. If it is denied, we will send you the reason, and your options. You can see on the PDL above which drugs need a PA. Questions? Call us.

How to Ask For a Medicine That is not on the PDL

You may ask us to cover a drug not on the PDL. This can be that you are allergic, not able to take a drug, or a poor response to it. You or a person allowed to represent you can give this request. We will then work with your provider to get the forms needed.

Generic Substitution

A drugstore will give you a generic drug instead of a brand-name one. Your provider will need our approval if they ask for a brand-name drug when a generic drug is available.

Therapeutic Interchange

If you have an allergy or can’t take a certain drug, your provider can ask us to cover some other drug.

Step Therapy

You may need to try one drug before another. You must try a PDL medicine before a drug that is not on the PDL. Certain drugs will be covered only if step therapy is used.

Quantity Limits

Some drugs have limits on how much can be given at one time. Quantity limits may be based on several factors. These can be recommended dosing, patient safety, or the Food & Drug Administration (FDA) rules.