The Board of Pharmacy posted numerous guidance updates related to the expiration of the Public Health Emergency and the policies and waivers they adopted during the COVID pandemic, including: 

• 2023-05-11 – Board Issues Updated Guidance Due to the End of Federal Public Health Emergency.pdf  
• Administration of COVID-19 Vaccines during the COVID-19 Pandemic.pdf 
• Board of Pharmacy – COVID-19 Response Efforts – Pharmacy Tech Vaccine Administration 
• Board of Pharmacy – COVID-19 Response Efforts 

To view the full list, go to Pharmacy.Ohio.Gov.   

Also in Ohio, the Ohio Department of Medicaid and Gainwell Technologies are continuing the reimplementation of prior authorizations (PA) based on specific drug classes. Of note, the PA reimplementation only applies to new, initial authorizations. It does not apply to those patients who have previously taken the drug supported by recent claims history prior to May 23, 2023. Phase 6 of reimplementation will begin on May 23 and contain the following:   

• Analgesic Agents: Gout  
• Blood Formation, Coagulation, and Thrombosis Agents: Colony Stimulating Factors, Hematopoietic Agents, Hemophilia Factor, Heparin-Related Preparations, Oral Anticoagulants, Oral Antiplatelets 
• Cardiovascular Agents: Angina, Hypertension and Heart Failure, Antiarrhythmics, Lipotropics  
• CNS Agents: Alzheimer’s Agents, Anticonvulsants Rescue, Fibromyalgia Agents, MAT of Opioid Addiction, Movement Disorders, Multiple Sclerosis, Narcolepsy, Neuropathic Pain, Smoking Deterrents
• Endocrine Agents: Diabetes- Hypoglycemia treatments, Endometriosis, Estrogenic Agents, Growth Hormone, Osteoporosis-Bone Ossification Enhancers, Progestin Agents, Uterine Fibroids 
• GI Agents: Pancreatic Enzymes, Proton Pump Inhibitors 
• Genitourinary Agents: Electrolyte Depleter Agents, Urinary Antispasmodics
• Infectious Disease: Antibiotics-Inhaled 
• Ophthalmic Agents: Antibiotic and Antibiotic-Steroid Combination Drops and Ointment, Antihistamines and Mast-Cell Stabilizers, Dry Eye Treatments, Glaucoma Agents, NSAIDS, Ophthalmic Steroids 
• Otic Agents: Antibacterial and Antibacterial/Steroid Combinations 
• Respiratory Agents: Antihistamines-Second Generation, Cystic Fibrosis, Epinephrine Auto-Injectors, Hereditary Angioedema, Inhaled Agents, Leukotriene Receptor Modifiers & Inhibitors, Monoclonal Antibodies-Anti-IL/Anti-IgE, Nasal Preparations, Other Agents 
• Topical Agents: Antifungals, Antiparasitics, Corticosteroids 

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. Please direct questions to the Gainwell Technologies Help Desk at 1-833-491-0344.  

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

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.

The Board of Pharmacy has posted the April 4 meeting agenda. Please note they plan to discuss the quota and break proposed rules from the Pharmacy Workforce Advisory Committee.

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

Medicaid published the following bulletins related to the Managed Care Program:

• Important notice regarding incorrect Payer ID for managed care claims
• ODM-06306 835 designation processing

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

ODM (Ohio Department of Medicaid) Director Maureen Corcoran announced a proposed 5.7% increase in the Professional Dispensing Fee (PDF) for the SPBM (Single PBM) pharmacy program as part of the biennial state budget. The percentage as proposed would be applied to all three PDF tiers. NACDS has been advocating for an increase since the September announcement of the PDFs for the SPBM The budget also includes an opportunity for pharmacies to enhance PDFs through a outcomes-based incentive payment. No further details are available upon this writing, but NACDS expects to have them soon.

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

ODM (Ohio Department of Medicaid) posted Myers & Stauffer’s 2022 Fee-For-Service Pharmacy Cost of Dispensing Survey report.  NACDS is currently analyzing the report that found that the cost to dispense increased since 2020 but that increase was mostly prevalent among smaller pharmacies. Survey results included a weighted mean of $9.46 and a weighted median of $8.44 as the cost to dispense for non-specialty providers.

Also in Ohio, ODM Director Maureen Corcoran testified about the proposed biennial budget proposal, confirming that the proposal includes funding for a “modest” pharmacy Professional Dispensing Fee (PDF) increase. NACDS has been advocating for an increase since the September announcement of the PDFs for the SPBM (Single PBM). No details are yet available, but NACDS expects to update members very soon.

Finally, in Ohio, ODM and Gainwell (SPBM) are continuing to re-implement prior authorizations (PA) requirements in stages by specific drug classes. The reimplementation only applies to new, initial authorizations. Phase 3 begins on February 14 for these specific classes:  

• Age Restricted Medications (denoted with “AR” on the UPDL (Unified Preferred Drug List)) 
• Benzodiazepines 
• Central Nervous System (CNS) Agents: Skeletal Muscle Relaxants, Non-Benzodiazepine
• Endocrine Agents: Diabetes- Insulin 
• Endocrine Agents: Diabetes- Non-Insulin 

Members can reference the Unified Preferred Drug List on the SPBM portal to see products that require a PA. Additional PAs will be reimplemented during the first quarter of 2023.  

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

The next payment for the Supplemental (managed care) dispensing fee (as pharmacy commonly refer to it) is scheduled to be paid to pharmacies between February 1-15. This is the first payment of the fee for 2023 and since the October 1 implementation of the SPBM. Under the SPBM, the payments will run as a special financial cycle and will appear on the non-Claim 835. You can identify these payments on your Remittance Advice by the reason code of 9638 – “QtrSuppDispFee.” For more information, please see the FAQ ODM was issued this week. The supplemental fee expires in June 2023, as it was meant to be a stopgap to assist pharmacies while the SPBM system was being developed. 

Also in Ohio, NACDS submitted a comment letter to the Common Sense Initiative (CSI) regarding the Board of Pharmacy’s proposed rule that would allow pharmacy technicians to administer vaccines. The letter expresses pharmacy’s strong support for the bill but asks that the CSI recommend that the Board remove the ratio for technician vaccinators and align the training requirement hours with the PREP Act.  

Finally in Ohio, the Department of Medicaid posted Myers & Stauffer’s 2022 Pharmacy Cost of Dispensing Survey report. NACDS is currently analyzing the report that found that the cost to dispense increased since 2022. They reported a weighted mean of $9.46 and a weighted median of $8.44 as the cost to dispense for non-specialty providers. 

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

The Board of Pharmacy (BOP) released another draft rule for stakeholder feedback from the Pharmacy Workforce Advisory Committee. This rule would establish mandatory breaks for pharmacy personnel. Members may submit comments to the BOP by January 20, 2023. Please note that the document also has guidance related to the current law around protections against employee violation reports to the Board.

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

The SPBM (Single Pharmacy Benefit Manager), Gainwell Technologies, sent a communication to pharmacies this week detailing claim recoupments that are planned in the next few weeks to compensate for overpayments in the first three weeks of the migration to the new Medicaid managed care pharmacy system.

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