This week, ODM (Ohio Department of Medicaid) (Ohio Department of Medicaid) reversed its policy that required provider participation in the Vaccines for Children (VFC) program under the SPBM (Single Pharmacy Benefit Manager), Gainwell. To increase access to pediatric vaccines, Gainwell announced they will now cover pediatric vaccine claims by non-VFC providers, reimbursing product costs and an administration fee. NACDS worked jointly with the Ohio Council of Retail Merchants and members to advocate for this policy with both ODM and the Governor’s office.

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

This week, Ohio Medicaid announced the payment schedule for the Supplemental Managed Care Dispensing Fee and that the fee has been increased due to the compressed schedule of payments. The payment schedule is:

Payment 5 – Between November 1 – 15, 2022 (July – Sept 2022 claims)

Payment 6 – Between February 1 – 15, 2023 (Oct – Dec 2022 claims)

Payment 7 – Between May 1 – 15, 2023 (Jan – March 2023 claims)

Payment 8 – No later than August 15, 2023 (April – June 2023 claims)

Note that the November payment will be issued by the Medicaid MCOs (Managed Care Organizations) and, as in the past, will be included in your weekly claim payments. However, the balance of the payments will come from Gainwell, the SPBM (Single Pharmacy Benefit Manager), as a separate payment. The FAQ document includes more detail.

Also in Ohio, Medicaid has prepared a toolkit for providers to prepare for the expiration of the federal Public Health Emergency (PHE). The materials are focused on the “unwinding” patient eligibility that will result at the end of the PHE.

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

As you are aware, Ohio Medicaid (ODM) implemented the Single PBM, Gainwell, at Midnight on October 1. NACDS has been working with members, ODM and Gainwell daily to provide solutions as they work through technical issues causing denials, many of which have since been resolved or temporarily patched over. To report any major system issues, please use the dedicated email that Gainwell/ODM is monitoring in real-time. If you need NACDS’ assistance to emphasize significant issues, please contact Jill McCormack.

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

NACDS reminds members that at midnight on Saturday Oct. 1 the state’s SPBM (Single Pharmacy Benefit Manager), Gainwell, will being processing managed care pharmacy claims. Beginning October 1, pharmacy benefits for managed Medicaid members will be covered by the Single Pharmacy Benefit Manager (SPBM), Gainwell Technologies. Gainwell’s provider manual, also known as the pharmacy reference guide, is the primary resource guide providing key information to pharmacy providers, pharmacy support staff, and prescribers. The provider manual includes information related to pharmacy claims submission, reimbursement rates, pharmacy network requirements, the specialty pharmacy program, claims processing, utilization management, and prior authorization. More information can be accessed at ODM’s Next Generation website or the Gainwell Ohio Pharmacy website. 

Also in Ohio, the Board of Pharmacy has posted the agenda for Public Hearing 10.26.22 and a document regarding the Pathway to Pharmacy Technician Registration for Veterans 

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

NACDS reminds members that Gainwell, the Ohio Medicaid Managed Care Single Pharmaceutical Benefits Manager (SPBM), will being offering pharmacies training on using the web portal on September 19. Registration instructions can be found on the Single PBM page. Select the selecting the provider resources tab, then clicking on “SPBM Web Portal Training.” Gainwell will be processing all Medicaid managed care claims beginning on October 1, 2022. 

Also in Ohio, the Board of Pharmacy has issued draft regulations allowing registered and certified pharmacy technicians to vaccinate. The rule makes technician immunization authority consistent with Ohio’s current pharmacist immunization authority as it relates to age and vaccine type, per passage of House Bill 6 of 2021. NACDS intends to comment on this rule. Please send Jill McCormack your comments by October 3.  

Finally in Ohio, Medicaid and Myers & Stauffer have announced an extension of the due date for the 2022 mandatory Cost of Dispensing Study to September 21 and have stated in a letter to pharmacies that this will be the final extension of the survey due date. 

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

Below are added items posted on the Board of Pharmacy’s website:  

• 202208 – Board Meeting Agenda – August 2022.pdf 
• Important Dates.pdf 
• Remote Order and Prescription Entry by Pharmacy Technicians and Pharmacy Interns.pdf 
• Remote Order and Prescription Processing by Pharmacists.pdf
• Wholesale Sales of Non-Controlled Dangerous Drugs Conducted Local Health Departments.pdf 

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

The Ohio Department of Medicaid (ODM) announced that the enhanced COVID-19 administration reimbursement rate for pharmacies will end on Sept. 30, 2022, as the new Single Pharmacy Benefits Manager (SPBM) program takes effect.  

Also in Ohio, the Board of Pharmacy issued guidance on the implementation of HB 193, which mandates electronic prescribing of Schedule II controlled substances. As the guidance notes, the law has a “safe harbor” provision which allows pharmacies to continue to fill paper prescriptions without verifying that the prescriber has an exemption. The law goes into effect on Sept. 23, 2022. Special thanks to the Ohio Council of Retail Merchants for working with NACDS and members during the legislative process to ensure that the “safe harbor” provision was included in the law. 

Also in Ohio, the Board of Pharmacy posted a notice regarding license renewals for Certified Pharmacy Technicians. The renewal process opens on Aug. 1, 2022. 

Finally in Ohio, the following are updates/reminders on the topic of the upcoming October implementation of the SPBM: 

• To request a spreadsheet on the new dispensing fees by store location, please email medicaidspbm@medicaid.ohio.gov and include a list of your store NPI numbers. 
• ODM sent a bulletin to pharmacies reminding them of important upcoming deadlines to participate in the SPBM program. 
• On August 3, 2022, the Cost of Dispensing survey that will be used to set rates in both the Fee for Service and the SPBM Managed Care programs be sent out to all enrolled Medicaid pharmacies by both US Mail as well as email, if ODM has an email for the pharmacy on record. Surveys are due back on September 14, 2022. Here is a copy of the draft survey instrument.
• Myers & Stauffer will host two instructional cost of dispensing survey webinars on Aug. 11 at 3:00 PM and Aug. 16 at 8:30 AM. Information to register for the webinars will be included in the survey packet sent to pharmacies. A draft of the dispensing survey tool can be viewed here.  
• For a list of specialty drugs and ingredient cost reimbursement by drug (OAAC (Ohio Average Acquisition Cost)) please visit the Myers & Stauffer Ohio Medicaid webpage. 

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

On July 19 at 11am ET, the Department of Medicaid (ODM) will hold an online seminar with Myers & Stauffer to discuss the upcoming mandatory Pharmacy Cost of Dispensing Survey. NACDS emailed the information to join the online seminar to members on our Ohio list. However, if you need the call-in information, please contact Jill McCormack.  

Also in Ohio, Myers & Stauffer has published the Specialty Drug list to be implemented in October concurrent with the new Single PBM program. 

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

Last week, Medicaid (ODM (Ohio Department of Medicaid)) held a pharmacy stakeholders’ online seminar where they announced pharmacy reimbursement rates under the Single PBM, “Next Generation of Managed Care Program.” The slides and a recording of the online seminar can be found on the SBPM website.

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