Pharmacy

Prescription Drug Benefits

With CareSource® MyCare Ohio (Medicare-Medicaid Plan), you get more of the drugs you need. And no copays for covered prescriptions and over-the-counter (OTC) drugs if you have CareSource MyCare Ohio for both Medicare and Medicaid. You also can use more than 63,000 pharmacies.

Comprehensive Drug Formulary

CareSource MyCare Ohio uses a Preferred Drug List.  This is also called a “formulary.” The list shows the drugs we want your doctor to order for you. Some drugs require prior authorization or are not covered by Medicare. Some drugs may also have quantity limits. And some drugs may require step therapy.

The comprehensive formulary is the entire list of Part D drugs covered by your Part D plan:

Notice of Formulary Changes – Throughout the year, changes may occur to drugs on our formulary. Check this list to view the updates.

Prior Authorization Criteria  Navigate2019  2018 – For certain drugs, your doctor will need to contact us before you can fill your prescription.

Step Therapy Criteria Navigate2019  2018 – For certain drugs, we require you to first try another drug to treat your medical condition before we will cover the drug your doctor initially prescribed.

Generics vs. Brand-Name Drugs

It is the policy of CareSource to limit the use of a brand-name drug when a generic version is available. Generally, a generic drug works the same as a brand-name drug and usually costs less. If there is a generic version of a brand-name drug, our network pharmacies will give you the generic version. Please see your member handbook on the Plan Documents page for exceptions.

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 FDA website.

Quality Assurance

CareSource understands that the accuracy of the formulary is very important. We have utilization management controls in place to promote safe and effective care for members. By reviewing prescription data, we aim to avoid errors and negative drug interactions. Sometimes we make changes to improve the safety and quality of what is available to you. We update the formulary monthly or note no change. We do regular audits to ensure the online formulary tool is only the CMS-approved version. We give 60 days’ notice to you when:

  • Taking a drug off the list
  • Changing a prior authorization
  • Changing a quantity limit
  • Changing a cost tier

You can ask us about drug safety at any time. You can access an online formulary or print one from our website. You may also ask us to mail you a copy. Just call our Member Services department.


CareSource® MyCare Ohio (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. This information is not a complete description of benefits. Limitations and restrictions may apply. For more information, call CareSource MyCare Ohio Member Services or read the CareSource MyCare Ohio Member Handbook. Benefits may change on January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

 


MyCare Ohio Logo Updated 09/28/2018
H8452_OHMMC-1225
CMS Approved 10/1/2018