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 – For certain drugs, your doctor will need to contact us before you can fill your prescription.
Step Therapy Criteria – 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.
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. Generally, if you are taking a drug on our formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. If these changes occur, no prior notification will be provided before the change is made. 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 30–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.
CMS/ODM Approved 02/11/2019