Ohio
The Board of Pharmacy published the agenda for the August 22 public hearing.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Ohio
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.
Ohio
This week, the Senate Finance Committee added language to the state budget bill (HB 33) to preserve the ability of pharmacists, pharmacy interns and pharmacy technicians to administer all ACIP-recommended vaccines to patients who are five years of age and older. It also eliminates the onerous requirement for a prescription for patients ages 7-12 years. NACDS is working diligently with in-state partners to preserve the language as the budget process moves forward. Your communication with Ohio Legislators is highly encouraged. Help us demonstrate to legislators the importance of this legislative remedy to patients in the communities we serve! Simply click here, type in your contact information, and the system will generate personalized communications to your state legislators.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Ohio
The Department of Medicaid (ODM) announced that on July 1, 2023, they will transition pharmacy benefits for Medicaid Fee-for-Service (FFS) enrollees to Gainwell, their single pharmacy benefits manager (SPBM). This transition consolidates oversight of Medicaid pharmacy benefits for managed care and FFS members, giving prescribers and providers one vendor to work with regardless of how their patients are enrolled in Medicaid. Beginning July 1, Medicaid FFS prescribers and pharmacies will route claims to Gainwell's new BIN 024251 and PCN OHRXPFFS. This information will be included on the new FFS member ID cards, but they will retain their current member ID numbers. The Pharmacy Reference Guide and Payer Sheet has been updated to reflect the changes. For questions about the transition, please email MedicaidSPBM@medicaid.ohio.gov
Also in Ohio, the Board of Pharmacy's final rule on pharmacists' immunizations authority was published, effective June 1. The rule reflects the passage of HB 6 of 2021 (134th GA). It updates the state's current practice to permit pharmacists to administer: Flu and COVID vaccines by protocol or vaccines for "any other disease" with a prescription to patients aged 7 years and older; and "any disease" under a protocol. Further regulations concerning technician and intern vaccines required under HB 6 are still in the rulemaking process. NACDS continues to work with our in-state partners and the Legislature to pass legislation to bring pharmacy immunization authority in line with the PREP (Public Readiness and Emergency Preparedness) Act.
Finally in Ohio, on May 24 the Board of Pharmacy posted numerous guidance documents regarding pharmacy technician and technician trainee registration, reciprocity and training programs. To view the documents please go to Pharmacy.Ohio.Gov.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Ohio
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.
Ohio
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.
Ohio
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.
Ohio
Medicaid published the following bulletins related to the Managed Care Program:
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Ohio
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.