Pharmacy

Prescription Drug Benefits

CareSource Medicare Advantage plans cover all medically necessary prescription drugs under Medicare Part B; see the Evidence of Coverage on the Plan Documents page for specific details. The plans use a formulary (a list of covered drugs) for drugs covered under Medicare Part D.

Here are some more important facts about the prescription program:

  • You may have copayments for your prescriptions.
  • You have to go to a pharmacy that accepts CareSource Medicare Advantage plans to get your prescriptions.
  • Your medication may have certain limitations.
  • The prior authorization requirements for your medicines may change.

To learn more about covered drugs, review our Drug Formulary webpage.

2019 Prescription Drug Coverage

CareSource Advantage Zero Premium (HMO)

Drug Tiers30-day retail90-day retail90-day mail order
Tier 1 (Preferred Generic)$6$18$0
Tier 2 (Generic)$15$45$37.50
Tier 3 (Preferred Brand)$47$141$117.50
Tier 4 (Non-Preferred Brand)$100$300$250
Tier 5 (Specialty)28% of the costNot Covered28% of the cost, 30-day supply only is covered

CareSource Advantage (HMO)

Drug Tiers30-day retail90-day retail90-day mail order
Tier 1 (Preferred Generic)$4$12$10
Tier 2 (Generic)$10$30$25
Tier 3 (Preferred Brand)$47$141$117.50
Tier 4 (Non-Preferred Brand)$100$300$250
Tier 5 (Specialty)33% of the costNot Covered33% of the cost, 30-day supply only is covered

CareSource Advantage Plus (HMO)

Drug Tiers30-day retail90-day retail90-day mail order
(Preferred Generic)$0$0$0
Tier 2 (Generic)$10$30$25
Tier 3 (Preferred Brand)$47$141$117.50
Tier 4 (Non-Preferred Brand)$100$300$250
Tier 5 (Specialty)33% of the costNot Covered33% of the cost, 30-day supply only is covered

2018 Prescription Drug Coverage

CareSource Advantage Zero Premium (HMO)

Drug Tiers30-day retail90-day retail90-day mail order
Tier 1 (Preferred Generic)$6$18$0
Tier 2 (Generic)$15$45$37.50
Tier 3 (Preferred Brand)$47$141$117.50
Tier 4 (Non-Preferred Brand)$100$300$250
Tier 5 (Specialty)28% of the costNot Covered28% of the cost, 30-day supply only is covered

CareSource Advantage (HMO)

Drug Tiers30-day retail90-day retail90-day mail order
Tier 1 (Preferred Generic)$4$12$10
Tier 2 (Generic)$10$30$25
Tier 3 (Preferred Brand)$47$141$117.50
Tier 4 (Non-Preferred Brand)$100$300$250
Tier 5 (Specialty)33% of the costNot Covered33% of the cost, 30-day supply only is covered

CareSource Advantage Plus (HMO)

Drug Tiers30-day retail90-day retail90-day mail order
(Preferred Generic)$0$0$0
Tier 2 (Generic)$10$30$25
Tier 3 (Preferred Brand)$47$141$117.50
Tier 4 (Non-Preferred Brand)$100$300$250
Tier 5 (Specialty)33% of the costNot Covered33% of the cost, 30-day supply only is covered

Need Help Paying for Your Prescription Drugs?

If you are in a program that helps pay for your drugs (extra help), the information about costs for Part D prescription drugs may not apply to you. Please review How to Get Help with Drug Costs to learn about your drug costs if you get extra help. Many people are eligible and don’t even know it. To see if you qualify, please follow the instructions in your Evidence of Coverage (Chapter 2, section 7). You can find this document and others on the Plan Documents page.

Pharmacies

In Ohio, CareSource features more than 1,100 pharmacies in our network:

  • More than 1,100 retail pharmacies
  • More than 50 long-term care pharmacies
  • More than 20 home infusion pharmacies

CareSource has contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area. You may go to any of our network pharmacies. To find a network pharmacy near you, use our Find a Pharmacy search tool.

CareSource offers mail-order service for prescription drugs. You can find additional information about this service on the Mail Order Drugs page and in your Evidence of Coverage on the Plan Documents page.

Formulary

The formulary is a list of all drugs covered under your plan. The formulary consists of more than 3,000 medications. CareSource provides monthly formulary updates to keep information current. For the most up-to-date information, you can always access our Find My Prescriptions online search tool.

Learn more about the Drug Formulary.

Drug Transition Policy

Under certain circumstances, CareSource can offer a temporary supply of a drug to you when your drug is not on the drug list or when it is restricted in some way. Doing this gives you time to talk with your provider about the change in coverage and figure out what to do.

Learn more about the Drug Transition Policy.

Medication Therapy Management Program

CareSource offers a Medication Therapy Management (MTM) program to ensure your covered Part D drugs are appropriate, to improve your medication use and to reduce the risk of adverse events like drug interactions. 

Learn more about the MTM program.

Drug Safety Recalls

Sometimes, the federal government issues drug recalls. To find out if a drug you take is being recalled, please check the listings on the U.S. Food & Drug Administration website.

Visit the Plan Documents page to view important documents about our plan’s prescription drug benefits.

Out-of-network/non-contracted providers are under no obligation to treat CareSource members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

CareSource is an HMO with a Medicare contract. Enrollment in CareSource Advantage® Zero Premium (HMO), CareSource Advantage® (HMO) and CareSource Advantage Plus® (HMO) depends on contract renewal. This information is not a complete description of benefits. Call 1-844-607-2827 (TTY: 1-800-750-0750 or 711) for more information. 


Y0119_OHMA-M-0251
Updated 10/1/2018
CMS Accepted 9/25/2018