This Drug List (formulary) is the CareSource Dual Advantage Plus (HMO D‑SNP) Drug List (Formulary) current as of 04/01/2026. It was developed with clinician consultation and lists the Part D covered drugs for the plan, organized by drug/treatment categories and an alphabetical index. The formulary shows each drug's plan tier and any utilization management controls that apply, including Prior Authorization (PA), Quantity Limits (QL), Step Therapy (ST), Mail‑Order (MO), Limited Access (LA), Non‑Extended Days' Supply (NDS), and B/D PA where a drug may be billed under Part B or Part D depending on setting.
The Drug List explains how to find drugs (by medical condition grouping or the index), definitions for generics and biosimilars, and the meaning of the requirement/limit abbreviations shown on each drug row. It describes member protections and procedures for mid‑year formulary changes: immediate substitutions (for certain new generics/biosimilars), removals, or other changes follow Medicare rules and are posted monthly, and affected members will be notified at least 30 days before a change takes effect or may receive a 30‑day supply when requesting a refill.
Members or prescribers may request exceptions (coverage, tiering, or to waive PA/QL/ST) by providing clinical justification. The plan generally decides standard exception requests within 72 hours of receiving the prescriber's supporting statement and provides expedited (24‑hour) review when waiting could seriously harm the member.
The formulary emphasizes that drugs are covered when medically necessary, filled at a CareSource Dual Advantage Plus network pharmacy, and when listed requirements/limits are met; out‑of‑network fills may result in full member liability. The document and online postings (updated monthly) show the list of covered Part D drugs, tiers, and the specific requirement/limit flags for each product entry.