The Board of Pharmacy is accepting comments for various rule sets up for the five-year rule review process. Comments are due to the Board on May 31 and should be posted here.
Also in Ohio, the state’s SBPM, Gainwell, announced the launch of their call center’s virtual agent, GABBYTM. GABBYTM is an interactive voice response system that offers several self-service functions, including checking claim statuses, member eligibility and prior authorizations. You can watch GABBYTM in action using this link.
Finally in Ohio, Gainwell will begin phase 5 of the re-implementation of Prior Authorization (PA) on May 9, 2023, on specific drug classes. Of note, the PA reimplementation only applies to new, initial authorizations, and it does not apply to those patients who have previously taken the drug supported by recent claims history prior to May 9. Phase 5 includes the following drug classes:
- Analgesic Agents: NSAIDS
- CNS Agents: Anti-Migraine Agents (Acute, Cluster Headache, Prophylaxis), Anticonvulsants, Antidepressants, ADHD Agents, Atypical Antipsychotics, Parkinson’s Agents, Restless Legs Syndrome, Sedative-Hypnotics (Non-Barbiturates)
- Compounding Agents (Bulk Chemicals/Powders, Vehicles, Bases)
- Gastrointestinal Agents: Anti-Emetics, Crohn’s Disease, Hepatic Encephalopathy, Irritable Bowel Syndrome (IBS) with Diarrhea, Ulcerative Colitis, Unspecified GI
- Infectious Disease Agents: Antibiotics – Cephalosporins, Macrolides, Quinolones, Tetracyclines
- Infectious Disease Agents: Antifungals
- Infectious Disease Agents: Antivirals – Herpes, HIV
Please reference the Unified Preferred Drug List (UPDL) posted on the SPBM portal to see products that require a PA. PAs may be submitted via phone, fax, mail and the SPBM portal. Additional PAs are planned for reimplementation in a similar, incremental fashion during the second quarter of 2023. Please direct questions to the Gainwell Help Desk at 1-833-491-0344.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.