Medicare Advantage Prescription Drug Coverage in Ohio

Understanding your Medicare prescription drug coverage should be simple. SummaCare Medicare Advantage plans include Medicare Part D prescription drug coverage to help you access the medications you need while managing your costs. This page gives you a clear overview of your pharmacy benefits, including covered drugs (formulary), payment options, pharmacy access and programs designed to support your health.

Appeals and Grievances Information

Can the Formulary Change?

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 we remove drugs from our formulary or add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a drug to a higher cost-sharing tier, we must notify affected members of the change at least 30 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 30-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug.

Find Your Pharmacy

Learn what pharmacies are in our network and search for pharmacies by using our Find Your Pharmacy tool.

Formulary Information

2026 Prior Authorization Requirements (SUM03) - Effective July 1, 2026

2026 Step Therapy Requirements (SUM03)- Effective July 1, 2026

2026 Transition Process (SUM03) - Effective October 15, 2025

How Does SummaCare Organize Covered Drugs?

SummaCare organizes our covered drugs into six tiers:

Tier 1 Preferred Generic
Tier 2 Generic
Tier 3 Preferred Brand Name
Tier 4 Non-Preferred
Tier 5 Specialty
Tier 6 Select Care Drugs

In addition, SummaCare covers some common non-prescription over-the-counter (OTC) generic drugs at a $0 copay if prescribed by a doctor.

Medicare Part D Prescription Drug Exceptions Process

If your drug is not included in the SummaCare Medicare Part D formulary (list of covered drugs), you can ask SummaCare to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make.

Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan is a payment option that works with your current drug coverage to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January–December). This payment option is free to those who opt in. All plans offer this payment option and participation is voluntary.

Learn More

Medication Therapy Management Program

If you’re in a Medicare drug plan and you have complex health needs, you may be able to participate in a Medication Therapy Management program, or MTM.

View the 2026 MTM program information.

MedImpact: Prescription Drug Mail Service

As a valued SummaCare member, we are happy to offer you a program for getting your routine prescription drugs delivered to your home through Birdi. The Birdi program is designed to reduce costs, ensure satisfaction and improve the convenience of home delivery while helping to manage the costs of your prescription drugs. Learn more about the Birdi program or download and print the Birdi Order Form.

Part D Prescription Drug Coverage

All SummaCare Medicare Advantage plans except for Amber (HMO) include Medicare Part D prescription drug coverage for no additional monthly plan premium.

Personal Prescription Coverage Information

Prescription Drug Formulary Information

The SummaCare Medicare Formulary is a list of covered drugs under each SummaCare Medicare Advantage plan. SummaCare will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy and other plan rules are followed.

SummaCare covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as brand name drugs. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

Vaccine Coverage

Most preventive vaccines are covered under Medicare Part D Prescription Drug Coverage while a few are covered under the Part B Medical Coverage. It’s important to know what vaccines are covered, your potential out-of-pocket costs and where to get your vaccine.

Learn more about vaccine coverage.

What Drugs Are Covered?

2026 Medicare Prescription Drug Formulary (SUM03) - Updated July 1, 2026

Formulary Change Notice 072026 Effective July 1, 2026

Formulary Change Notice 062026 Effective June 1, 2026

Formulary Change Notice 052026 Effective May 1, 2026

Formulary Change Notice 042026 Effective April 1, 2026

Formulary Change Notice 04012026 Effective April 1, 2026

Formulary Change Notice 032026 Effective March 1, 2026

Formulary Change Notice 022026 Effective February 1, 2026

2026 Medication Therapy Management Program

Get personalized support from a pharmacist to help you manage your medications and improve health outcomes. Eligible members may receive a comprehensive review of their prescriptions at no additional cost.

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2026 Medicare Prescription Payment Plan

Learn how the Medicare Prescription Payment Plan can help spread your out-of-pocket prescription drug costs into manageable monthly payments. Explore eligibility requirements and enrollment information.

Learn more

Determinations, Appeals & Grievances: Part D

Understand your rights and options if you disagree with a coverage or payment decision. Find information on how to request a determination, file an appeal, or submit a grievance.

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2025 Medicare Prescription Payment Plan

Access information about the 2025 Medicare Prescription Payment Plan, including how it works and who may qualify. Review important details for current plan year participants.

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Medicare Part D Prescription Drug Exceptions Process

Learn how to request an exception if a medication is not covered or if you need coverage under different terms. Find guidance on the requirements and steps involved in the process.

Learn more

Vaccine Coverage

Learn which vaccines are covered under your Medicare plan and where to receive them. Review coverage details to help you stay up to date on recommended immunizations.

Learn more

Questions? We're here to help.

Phone

330.996.8885 Member Services

1.800.996.6250 Toll Free

Email

info@summacare.com Existing Members

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Outside these hours, you may leave us a message and a representative will return your call the next business day.

Prescription Drug Benefits

Appeals and Grievances Information

Can the Formulary Change?

Find Your Pharmacy

Formulary Information

How Does SummaCare Organize Covered Drugs?

Medicare Part D Prescription Drug Exceptions Process

Medicare Prescription Payment Plan

Medication Therapy Management Program

MedImpact: Prescription Drug Mail Service

Part D Prescription Drug Coverage

Personal Prescription Coverage Information

Prescription Drug Formulary Information

Vaccine Coverage

What Drugs Are Covered?

2026 Medication Therapy Management Program

2026 Medicare Prescription Payment Plan

Determinations, Appeals & Grievances: Part D

2025 Medicare Prescription Payment Plan

Medicare Part D Prescription Drug Exceptions Process

Vaccine Coverage

Questions? We're here to help.

Phone

Email

Hours

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