NACDS reminds members that beginning July 1, Medicaid Fee-for-Service (FFS) pharmacy claims should be submitted to Gainwell with the BIN of 024251, a PCN of OHRXPFFS and the same 12-digit Medicaid ID number used to bill FFS today. All ODM-enrolled pharmacies will be able to submit FFS claims. No separate contracting with the SPBM is required. 

Additionally, prior authorization management will also transition to Gainwell beginning July 1. On this date, prescribers should begin submitting prior authorization requests to Gainwell, using the same forms and processes as used under the SPBM managed care program. All active prior authorizations on file with Change Healthcare will be transferred to Gainwell and will be honored through their original expiration date. 

Pharmacies and pharmacists can find the FFS Pharmacy Reference Guide and Payer Sheet at: Pharmacy Billing Information | pharmacy.medicaid.ohio.gov. 

Also in Ohio, The Common Sense Initiative (CSI) is reviewing the following Board of Pharmacy proposed rules to assess any adverse impact on the business community. To review the Board’s Business Impact Analysis and provide comments to CSI, please click on the links below. 

• 29:6-3-09 – Satellite Distribution Sites During a Public Health Emergency 
• 4279:5-3-21 – Point of Dispensing Locations During a Public Health Emergency  
• 4729:7-3-06 – Allows pharmacists to conduct medication validation (e.g., the final check) of a drug compounded in a prescriber clinic. 

The Board of Pharmacy is also seeking comments by July 28 on adding Nalmefene Nasal Spray under the definition of an overdose reversal drug to make it be available for widespread lay distribution in Ohio without a prescription, like naloxone. 

For more information, contact NACDS’ Jill McCormack at 717-592-8977.