Gainwell Technologies, the Medicaid Single PBM (SPBM), announced effective April 1 brand Suboxone will transition to non-preferred status and will require Prior Authorization (PA). Generic buprenorphine/naloxone will remain Preferred (No PA Required). The announcement further encouraged pharmacies to ensure they have advance supplies of the preferred product to manage this utilization shift without patient interruption.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Senate Health Committee met on February 18 and heard proponent testimony on SB 230, legislation that would allow pharmacists to test and treat patients with common illnesses. NACDS attended the hearing, submitted written testimony and helped coordinate testimony with members and in-state partners. The bill is necessary for the state to move forward with the pharmacy initiatives in its Rural Health Transformation Program (RHTP) plan. We expect the bill to advance this spring. Senate Health Committee Chair Steve Huffman (R) recently authored a Columbus Dispatch column highlighting the importance of passing legislation related to the RHTP.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The state released its first pharmacy-related Rural Health Transformation Program (RTHP) Request for Proposals (RFP), seeking a project manager for the Rural Health Workforce Recruitment, Retention and Upskilling Pipeline Program. The program envisions pharmacies playing a key role in both the workforce initiative, and in the “upskilling” portion of the program. The RFP specifically calls for the development of training programs for pharmacists to deliver point-of-care “test and treat” services in rural areas.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The state released its first Rural Health Transformation Project (RTHP) Request for Proposals (RFP) seeking a project manager for the Rural Health Workforce Recruitment, Retention and Upskilling Pipeline Program. As outlined in the RFP, the program envisions pharmacies playing a key role in both the workforce initiative, and in the “upskilling” portion of the program. The RFP specifically calls for the development of training programs for pharmacists to practice at the top of their license to support point-of-care test and treat services. We urge members to review the RFP for awareness and preparation. Members may review the RFP and supporting materials on OhioBuys website.
Also in Ohio, the Board of Pharmacy released a draft Electronic Verification Rule (4729:5-3-25) that would authorize and regulate electronic product verification. The rule would allow a pharmacist to use technology to complete final product verification from a remote site. The rule is not specific to any practice site but specifies that it does not apply to remote dispensing pharmacies or automated dispensing systems. Please send any feedback you may have to Jill McCormack as soon as possible, as the comment deadline is January 15.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The state's single Medicaid PBM, Gainwell, announced that, effective December 8, claims for preferred GLP-1 receptor agonists (listed below), will require a diagnosis of 'diabetes mellitus, type 2' to be documented in the member's medical record (as determined by medical claims data) or submitted on the pharmacy claim. For members with a diagnosis of 'diabetes mellitus, type 2' documented, claims will continue to be eligible for coverage under the state's Medicaid pharmacy benefit. For all other non-FDA approved uses (such as prediabetes or weight loss), coverage will not be available. Please note claims and associated diagnoses are subject to audit, and results will be reviewed by the Department of Medicaid for compliance. Diagnosis codes must be submitted by the prescriber on the original prescription or added by the pharmacy in consultation with the prescriber, with documentation of the date, time and name of the individual providing the diagnosis, in addition to the name of the pharmacy staff member verifying the diagnosis.
Preferred GLP-1 receptor agonists include:
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Gov. Mike DeWine (R) announced that he is nominating Scott R. Partika to be the director of the Department of Medicaid, following the announcement that Director Maureen Cocoran is retiring. Partika's nomination must be confirmed by the Senate.
Also in Ohio, the Board of Pharmacy has posted the following:
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The House Insurance Committee held a proponent hearing on HB 192 as amended. You can watch the hearing here. NACDS’ submitted written testimony in support of the bill.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Effective October 1, the quarterly supplemental dispensing fee that has been paid to retail pharmacies in Ohio since 2020 ended and became part of the claim-based dispensing fee structure. This resulted in a 9.6% dispensing fee increase for managed care pharmacy claims under the Single PBM. The increases range from $0.78 to $1.06 across the three dispensing fee tiers. Gainwell’s Frequently Asked Questions: Managed Care Pharmacy Dispensing Fees (October 2025 Update) provides further details. You can also utilize the dispensing fee lookup dashboard to check pharmacy tier designations and determine a location’s new dispensing fee.
Also in Ohio, Gainwell issued the following announcement: On October 1, 2022, Gainwell Technologies became the Single Pharmacy Benefit Manager (SPBM) for the Ohio Department of Medicaid (ODM). ODM only covers drugs that are part of the Medicaid Drug Rebate Program, with limited exceptions.
ODM was recently notified that drug manufacturer, Bausch Health, has decided to no longer participate in the Medicaid Drug Rebate Program. This means that medications made by this manufacturer will no longer be covered by Ohio Medicaid, effective November 1, 2025. The most common medications affected include: Aplenzin, Xifaxan, Relistor, Siliq, Jublia, and Trulance.
The manufacturer of these medications has extended coverage for selected drugs for Medicaid enrollees through their Patient Assistance Program. This program may provide the prescribed medication at no cost to your patient. More information about this option can be found at the following website: https://www.bauschhealthpap.com.
Prescribers also have the option to select an alternative covered medication from the Ohio Medicaid Unified Preferred Drug List (UPDL), found at: https:\\spbm.medicaid.ohio.gov. Select ‘Reference Material,’ then ‘Drug Coverage,’ and then ‘UPDL effective 10.01.2025’ and/or ‘OH SPBM Medical Necessity Policy.’
Affected Medicaid enrollees and prescribers have been notified of these changes. They may contact you, as their pharmacy provider, for additional guidance in navigating this change. We are providing this notification as a courtesy so that you are aware of the changes and recommended course of action to best help your patients. Thank you for your willingness to assist in this capacity.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
The Board of Pharmacy posted the following rules. NACDS does not intend to comment on these. Members can find more information on submitting comments in the links.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
