Posts Tagged ‘copay’

Pharmacy Carve In

Author : CareSource

Sep 29th, 2011 | by CareSource

Blog post by Jim Gartner, Vice President of Pharmacy, CareSource

Beginning October 1, CareSource will provide pharmacy benefits to our members.  What does this all mean? It means our members will receive even better care because we will be able to coordinate their doctor appointments, treatment options and prescription drugs. We will also be able to monitor what medications our members are receiving, if they’re taking their medication and how much they’re taking.

The biggest part of this change is that our members will no longer pay a co-pay for their medications.  This will take the worry and burden away for our members who already struggle with many other financial burdens. Many of our members live every day wondering how they will pay their electric bill or buy groceries. Health care and prescription coverage should be something they don’t have to worry about.  

Pharmacy TeamThe pharmacy team at CareSource has been gearing up for this change for months and we’re excited to provide greater coordination in the pharmacy benefit. In fact, at our All Staff meeting in July, the pharmacy team put on a little dance to remind our staff of the coming change.

We like to have fun at CareSource so everyone enjoyed the song our pharmacy team developed to educate their peers about the importance of coordinating pharmacy benefits.

I came to CareSource with a plan
To help our fellow, fellow man
Prescription drugs are not meant to abuse
It is our job to drive proper use

Pharmacy Carve In, makes it right
Pharmacy Carve In, helps the fight
Pharmacy Carve In, we are one
Here it comes, October One

You can also watch our video of us making fools of ourselves.  

Pharmacy Carve In Video

All joking aside, we truly believe that pharmacy carve in will be beneficial to our members’ health and well being. And we’re honored to help.

Below is some helpful information from the State of Ohio regarding the pharmacy benefit change. If you can’t find an answer to a question or need assistance, please call our member services team at 1-800-488-0134, Monday through Friday, 7:00 am to 7:00 pm.

Changes in Your Ohio Medicaid Prescription Coverage Starting October 1, 2011

These changes affect everyone in your family who gets health care through an Ohio Medicaid managed care plan (MCP).

Starting October 1, 2011, your managed care plan (MCP) will pay for prescription drugs and certain prescription medical supplies (diabetic supplies, inhaler spacers, peak flow meters, syringes, needles, alcohol wipes, and condoms).  This means that you will need to get your prescription drugs at a pharmacy that accepts your MCP.  You may no longer have to pay a co-payment for prescription drugs.  Your MCP will notify you in writing if any co-payment for prescription drugs will apply to you. 

This is how the changes will affect you when you get your prescription drugs and certain prescription medical supplies starting October 1, 2011.

  1. Starting October 1, you must use your new card to get prescriptions at the pharmacy, and to get medical supplies and other health care through your MCP.  Your new card lets pharmacies know that your MCP will pay for your prescriptions.  Contact your MCP if you do not receive your new card.
  2. You can get your prescription drugs at any pharmacy that accepts your MCP. Your MCP will only pay for prescriptions you get from pharmacies that have a contract with your MCP.  Ask your pharmacy if it accepts your MCP.  If you plan to travel out-of-state, be sure to fill your prescriptions before you leave. 
  3. You can keep getting certain prescription medical supplies at no cost to you (diabetic supplies, inhaler spacers, peak flow meters, syringes, needles, alcohol wipes, and condoms). The pharmacy or medical equipment supplier cannot charge you for these prescription medical supplies. Contact your MCP about how to obtain your medical supplies.
  4. Your MCP will require your doctor to get prior authorization for some prescription drugs. Your MCP will not pay for some prescription drugs unless it gave your doctor prior authorization for the prescription. If your MCP requires prior authorization for one of your prescriptions but your doctor has not gotten it, the pharmacy will tell you that your MCP will not pay for the prescription unless your doctor gets prior authorization.  If you need to fill the prescription immediately but your doctor is not available to get prior authorization, ask the pharmacy about giving you a short-term supply of the prescription.

 Ask your doctor or pharmacy if there is another prescription that will work for you that does not require MCP prior authorization. 

If Ohio Medicaid paid to refill a prescription on or after April 1, 2011 for a drug that needs MCP prior authorization and you need to refill the prescription on or after October 1, 2011:

  • If it is for a controlled substance, you can refill it without MCP prior authorization until October 31, 2011. Controlled substances include many pain medications such as medications containing hyrdrocodone, some anxiety medications such as diazepam, and some seizure medications such as Phenobarbital. Ask your pharmacist whether any of your medications are controlled substances;
  • If it is not for a controlled substance, you can refill it without MCP prior authorization until December 31, 2011;
  • If it is for a tablet/capsule antidepressant or antipsychotic, or an injectible antipsychotic or an injectible antipsychotic, you can refill it without MCP prior authorization unless:
    • It is not prescribed by a psychiatrist who has a contract with your MCP or whom you see at a Community Mental Health Center;
    • Or is not prescribed for use as approved by the FDA.
    • If either of these applies, then you can refill it without MCP prior authorization until January 31, 2012.


If you refill a prescription for a drug that needs MCP prior authorization, you will receive a letter from your MCP giving you information about what your doctor needs to do. 

More information and help is available. Questions or problems with your prescription coverage or pharmacy?  Questions or problems with your doctor?  Contact your managed care plan (MCP) at the toll-free number on your member ID card.

No Comments » Read More