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.

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.