Pharmacy

With CareSource MyCare Ohio you get more of the medications you need with no copays for covered prescriptions and some non-part D and over-the-counter (OTC) drugs.

We partner with Express Scripts® to help you manage your prescriptions.

List of Covered Drugs (Formulary)

If you get both your Medicare and Medicaid benefits from CareSource, the formulary (Navigate English  |  Navigate Spanish) is the entire list of Part D drugs covered by your Part D plan.

Prior Authorizations

Some prescriptions may need a prior authorization. This means that it will need to be reviewed and approved by us before you can fill it. Your provider will make this request for you. View the prior authorization criteria list. We will also post any updates to this list here.

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.

Medicaid List of Covered Drugs

The Navigate Medicaid List of Covered Drugs outlines the coverage for certain OTC items and non-Part D drugs included in your plan. This list is what Medicaid-Only members can use to find what is covered in their plan.

Ask Your CareSource Pharmacist

Do you have questions about your medications? Talk to a CareSource pharmacist! You do not need an appointment. Call 1-833-230-2073 (TTY: 711) to speak with a pharmacist today. We are open Monday through Friday, 8 a.m. to 5 p.m. Eastern Time.

Generic vs. Brand-Name Drugs

Our policy is 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 Evidence of Coverage (EOC) or Medicaid-Only Member Handbook for exceptions.

Drug Safety Recalls

Sometimes, the federal government or drug manufacturer issues drug recalls. To find out if a drug you take is being recalled, please check the listings on the Food and Drug Administration (FDA) website.

Quality Assurance

We know that the accuracy of the formulary is important. We regularly check to make sure the online formulary tool is the approved version. 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. There are times when this may change like when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug becomes available. If these changes occur, no prior notification will be provided before the changes are made. However, we will 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 Member Services at 1-855-475-3163 (TTY: 1-833-711-4711 or 711).