CareSource MyCare Ohio (Medicare-Medicaid Plan) Formulary



Below is the 2023 Formulary, or prescription drug list, from CareSource MyCare Ohio (Medicare-Medicaid Plan) by Caresource Ohio, Inc. A formulary is a continually updated list of available medications and prescription drug cost information. Examining a plans formulary can help you find a Ohio Medicare Part-C plan that covers your prescriptions. It also helps you compare costs among Medicare Part D and Medicare Advantage plans available to you. You’ll want to make sure the medicines you are currently taking are covered under any plans you are considering enrolling in.

This CareSource MyCare Ohio (Medicare-Medicaid Plan)(H8452-001) plan has a $0 drug deductible. The Initial Coverage Limit (ICL) for this plan is $NA. The Initial Coverage Period is the period after the Deductible has been met but before the Coverage Gap phase. Once you and your plan provider have spent $NA on covered drugs. (Combined amount plus your deductible) You will enter the coverage gap. (AKA "donut hole") Once you reach the coverage gap you will be required to pay 25% of the plan's cost for covered brand-name prescription drugs unless your plan offers additional coverage. You can see if this plan offers coverage in the "donut hole" by clicking the "Coverage Gap" link above the chart.

In 2023 if you have spent $7400 in expenditures you enter the Catastrophic Phase. During the Catastrophic Period you will begin to receive significant coverage. Caresource Ohio, Inc will begin paying approximately 95% of your covered medication expenses. You can see if this plan covers your drugs in the Catastrophic Phase by clicking the "Catastrophic" link above the chart.



Plan Overview

Plan Name:CareSource MyCare Ohio (Medicare-Medicaid Plan)
Plan ID: H8452-001
Provider: Caresource Ohio, Inc
Plan Year:2023
Premium:$0.00
Deductible:$0
Initial Coverage Limit:$NA
Coverage Area:Ohio
Similar Plan:H8452-001


Change Table Options:

Drugs Starting Letter:
Coverage Phase:

*Tip Click the Drug name to Compare Coverage and Retail Cost for Every Plan In Your Area
⇅ Click the Header to Sort
Drug
Name⇅
Tier
Level
Cost
Preferred
Cost
Non
Preferred
Cost
Mail
Limit
Amt/Days
Prior Auth
Y/N
Step
Therapy
Cabergoline
1NA$0NANN
Cablivi
2NA$0NAYN
Cabometyx
2NA$0NA30/30YN
Calcipotriene
1NA$0NA120/30NN
Calcitriol
1NA$0NANN
Calcium Acetate
1NA$0NA360/30NN
Calquence
2NA$0NA60/30YN
Camila
1NA$0NANN
Candesartan
1NA$0NANN
Candesartan Cilexetil And Hydrochlorothiazide
1NA$0NANN
Caplyta
2NA$0NA30/30NN
Caprelsa
2NA$0NA30/30YN
Captopril
1NA$0NANN
Carbamazepine
1NA$0NANN
Carbidopa
1NA$0NANN
Carbidopa And Levodopa
1NA$0NANN
Carbidopa, Levodopa, And Entacapone
1NA$0NANN
Carglumic Acid
1NA$0NAYN
Carteolol Hydrochloride
1NA$0NANN
Cartia
1NA$0NANN
Caspofungin Acetate
1NA$0NANN
Cayston
2NA$0NA84/56YN
Caziant
1NA$0NANN
Cefaclor
1NA$0NANN
Cefadroxil
1NA$0NANN
Cefazolin
1NA$0NANN
Cefdinir
1NA$0NANN
Cefixime
1NA$0NANN
Cefoxitin
1NA$0NAYN
Cefpodoxime Proxetil
1NA$0NANN
Cefprozil
1NA$0NANN
Ceftazidime
1NA$0NAYN
Ceftriaxone Sodium
1NA$0NANN
Cefuroxime
1NA$0NAYN
Celecoxib
1NA$0NANN
Celontin
2NA$0NANN
Cephalexin
1NA$0NANN
Cevimeline
1NA$0NANN
Chemet
2NA$0NAYN
Chenodal
2NA$0NAYN
Chlorpromazine Hydrochloride
1NA$0NANN
Chlorthalidone
1NA$0NANN
Cholbam
2NA$0NAYN
Cholestyramine
1NA$0NANN
Ciclopirox
1NA$0NA120/28NN
Ciclopirox Olamine
1NA$0NA60/28NN
Cilostazol
1NA$0NANN
Cimduo
2NA$0NANN
Cimetidine
1NA$0NANN
Cimetidine Hydrochloride
1NA$0NANN
Cimzia
2NA$0NA2/28YN
Cinacalcet Hydrochloride
1NA$0NAYN
Cinryze
2NA$0NAYN
Ciprofloxacin
1NA$0NANN
Ciprofloxacin And Dexamethasone
1NA$0NANN
Ciprofloxacin Otic
1NA$0NANN
Citalopram Hydrobromide
1NA$0NANN
Claravis
1NA$0NANN
Clarithromycin
1NA$0NANN
Clindamycin
1NA$0NAYN
Clindamycin Hydrochloride
1NA$0NANN
Clindamycin In 5 Percent Dextrose
1NA$0NAYN
Clindamycin Palmitate Hydrochloride (pediatric)
1NA$0NANN
Clindamycin Phosphate
1NA$0NANN
Clinimix
2NA$0NAYN
Clobazam
1NA$0NA480/30YN
Clobetasol Propionate
1NA$0NA118/28NN
Clodan
1NA$0NA236/28NN
Clomipramine Hydrochloride
1NA$0NANN
Clonazepam
1NA$0NA300/30NN
Clonidine Hydrochloride
1NA$0NANN
Clonidine Transdermal System
1NA$0NA4/28NN
Clorazepate Dipotassium
1NA$0NA180/30YN
Clotrimazole
1NA$0NANN
Clotrimazole And Betamethasone Dipropionate
1NA$0NA60/28NN
Clotrimazole Topical Solution Usp, 1%
1NA$0NA30/28NN
Clozapine
1NA$0NANN
Coartem
2NA$0NANN
Colchicine
1NA$0NANN
Colesevelam Hydrochloride
1NA$0NANN
Colestipol Hydrochloride
1NA$0NANN
Collagenase Santyl
2NA$0NA180/30NN
Combivent Respimat
2NA$0NA8/30NN
Complera
2NA$0NANN
Compro
1NA$0NANN
Corlanor
2NA$0NA450/30NN
Cotellic
2NA$0NA63/28YN
Creon
2NA$0NANN
Cresemba
2NA$0NAYN
Cromolyn Sodium
1NA$0NANN
Crotan
1NA$0NANN
Cryselle
1NA$0NANN
Cyclobenzaprine Hydrochloride
1NA$0NAYN
Cyclophosphamide
1NA$0NAYN
Cyclosporine
1NA$0NAYN
Cyred Eq
1NA$0NANN
Cystagon
2NA$0NAYN

* Drug Prices and Coverage is for a 30 Day Supply



Additional Notes by Medicare Help:

Coverage Levels for H8452-001

Most plans have 4 levels of coverage. The exception is the $0 Deductible Plans.
1. Pre-Deductable: Before you reach the plans deductible of $0. Some plans offer select Pre-deductible drug Coverage
2. Initial Coverage: (ICL) After you reach the plans deductible but before the Initial Coverage limit of $NA
3. Coverage Gap: (AKA Donut Hole) After you reach the plans ICL but before the Catastrophic of $7400 in 2023.
4. Catastrophic: Anything over $7400 you will receive a significant increase in coverage.

Definitions:

Premium: A monthly flat fee that varies by plan.
Deductible: The amount you must pay each year for your prescriptions before your plan begins to pay its share of your covered drugs. The max in 2023 is $505. Some plans have a $0 Deductible.
Tier Level: Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost. A drug in a lower tier will generally cost you less.
Quantity Limit Amount/Days: Certain drugs have a Quantity Limit. That means the plan will only cover the drug up to a designated quantity or amount. If your prescribing doctor feels it is necessary to exceed the set limit, he or she must get prior approval before the higher quantity will be covered.
Prior Authorization: Certain Drugs require you or your doctor to get prior authorization to be covered. Usually just an additional form. If you dont get approval, the plan may not cover the drug.
Does the Deduct Apply: Some drugs do not require that the deductible is met before you receive coverage.
Step Therapy: Means you must first try one drug to treat your medical condition before the plan will cover another drug for the same condition. If you have already tried other drugs or your doctor thinks they are not right for you, you and your doctor can ask the plan to cover this drug.
Cost Preferred: Your Cost for the Drug at the Providers In-Network Preferred Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Non-Preferred: Your Cost for the Prescription Drug at a Non-Preferred Pharmacy. As a Percent of the total drug cost or a flat rate.
Cost Mail: Your Cost for Prescription Drugs through a Mail Order Pharmacy. As a Percent of the total drug cost or a flat rate.


What if a drug I need is not listed?

Please check the formulary for different brand and generic names. If you still cannot locate your drugs, your plan may not offer coverage. Talk to your doctor first about changing your prescription to a drug on your plan's formulary. If this is not an option, you can request an exception to have the plan review its coverage decision based on your individual circumstances.

Last updated on

Source:CMS Formulary Data Q4 2022
Source:NDC Directory by FDA.gov

**We make every attempt to keep our information accurate. But please check with the plan providers to verify all information.

      Site Search:

MedicareHelp.org is a privately-owned Non-governmental agency. The government website can be found at HealthCare.gov.

Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.

Every year, Medicare evaluates plans based on a 5-star rating system.