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. 

• CSI – BIA – Responsible Person Requirements (Comments Due 8.11.2025).pdf – requires minimum work hours for the Pharmacist-in-Charge (PIC) 

• For Stakeholder Comment – Manner of Issuance (Comments Due 8.1.2025).pdf – requires a child's weight on certain pediatric prescriptions 

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

Sen. Mark Romanchuk (R) has introduced SB 230, legislation permitting pharmacists to test and treat patients for flu, strep, COVID-19, RSV and other respiratory conditions as specified in future rules adopted by the Board of Pharmacy. The Legislature has adjourned for the summer, so we do not expect any action on the bill before the fall.

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

The Budget Conference Committee approved an amended version of the state budget that will soon be on Gov. Mike DeWine’s (R) desk. Though NACDS worked strategically with members and partners to include a meaningful commercial pharmacy rate floor, the conference committee fell woefully short, fueled by the Ohio Chamber of Commerce’s claims that a rate floor would raise consumer premiums. The final language, which only applies to pharmacies incorporated in the state, sets the ingredient cost floor at either the amount a PBM pays its affiliates or actual acquisition cost (ACC); however, it does not include a dispensing fee rate floor. NACDS is analyzing the impact of the language and will seek member feedback on any next steps.

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

This week, the Senate released an amended version of the state budget bill, HB 96, which did not retain the House's provision requiring a pharmacy commercial rate floor. Both the Ohio Chamber of Commerce and the National Federation of Independent Business (NFIB) actively opposed the amendment. NACDS continues to collaborate with partners and members to promote commercial PBM reform, with a focus on restoring the pharmacy rate floor during the conference committee process.  

Also in Ohio, NACDS also submitted written testimony to the House General Government Operations Committee urging its support for HB 229, requiring PBM licensure and reporting. The bill had its second hearing this week.  

Finally in Ohio, Medicaid released an updated preferred diabetic supply list, effective June 1. 

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

The Board of Pharmacy issued the following bulletins:  

• Pharmacy Continuous Quality Improvement Programs for Dispensing Errors 

• Pharmacy Duty to Report Requirements 

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

The Board of Pharmacy announced that they have developed and posted a new tool in the form of a dashboard that provides data on pharmacy trends and access in the state. The dashboard includes data on closures, openings and “pharmacy deserts” across communities.

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

Effective January 1, 2025, At-home COVID-19 test kits will no longer be covered under pharmacy benefits for Medicaid fee-for-service (FFS) and managed care members. Any claims received on or after January 1 will result in a rejection. Patients may obtain free At-home COVID-19 test kits and access additional resources for free testing by visiting the Department of Health and Human Services’ COVID testing page. If you have questions, please contact the Gainwell single PBM (SPBM) Customer Service Center at 833-491-0344.

Also in Ohio, the Board of Pharmacy released its 2025 meeting schedule.

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

The Department of Medicaid announced the selection of four managed care plans they will contract with for the “Next Generation of MyCare,” Medicaid’s dual eligible healthcare program. The new plan contracts will begin January 1, 2026.

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