Medicaid.ohio.gov

Drug Coverage Information pharmacy.medicaid.ohio.gov

Drug Coverage Information. The Ohio Department of Medicaid (ODM) provides coverage of both prescription and over-the-counter drugs. The links below allow both providers and beneficiaries to find information about drug coverage. These resources include a web-based Drug Look Up Tool that may help answer questions not specifically addressed in the

Actived: 8 days ago

URL: pharmacy.medicaid.ohio.gov


Welcome to the Ohio Medicaid Pharmacy Program pharmacy

(5 days ago) The Ohio Medicaid Drug program is a federal and state supported program that provides prescription drug coverage to eligible recipients. The Ohio Department of Medicaid (ODM) administers the program which encompasses over 30,000 line items of drugs from nearly 300 different therapeutic categories.

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Unified Preferred Drug List

(8 days ago) The Statewide PDL is not an all-inclusive list of drugs covered by Ohio Department of Medicaid. Medications that are new to market will be non-preferred until reviewed by Ohio Department of Medicaid's Pharmacy and Therapeutics Committee. The list is set up in sections defined by therapeutic class. Products are listed by generic name if the generic

Category:  Medications,  Pharmacy Go Now


OAC 5160-9-03 List of Drugs Covered Without Prior

(8 days ago) list of drugs covered without prior authorization vyvanse cap 60mg $2.00 n vyvanse cap 70mg $2.00 n zenzedi tab 10mg $0.00 n zenzedi tab 5mg $0.00 n neomycin tab 500mg $0.00 n paromomycin cap 250mg $0.00 n arcalyst inj 220mg $2.00 n celecoxib cap 100mg $0.00 n celecoxib cap 200mg $0.00 n celecoxib cap 400mg $0.00 n

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Preferred Drug List

(3 days ago) STEP THERAPY: Long-acting drugs 1. For a preferred brand, there must have been inadequate clinical response to preferred generic alternatives, including a trial of no less than one week of at least one preferred generic 2. For a non-preferred drug, there must have been inadequate clinical response to …

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Unified Preferred Drug List

(1 days ago) The Statewide PDL is not an all-inclusive list of drugs covered by Ohio Department of Medicaid. Medications that are new to market will be non-preferred until reviewed by Ohio Department of Medicaid's Pharmacy and Therapeutics Committee. The list is set up in sections defined by therapeutic class. Products are listed by generic name if the generic

Category:  Medications,  Pharmacy Go Now


OAC 5160-9-03 List of Drugs Covered Without Prior

(4 days ago) List of Drugs Covered Without Prior Authorization 11/1/2017 Page 7 of 119 Drug Name CoPay Covered for Dual Eligible ANALGESICS - OPIOID HYDROCO/APAP SOL 7.5-325 $0.00 Y HYDROCO/APAP SOL 7.5-500 $0.00 Y HYDROCO/APAP TAB 10-325MG $0.00 Y HYDROCO/APAP TAB 2.5-325 $0.00 Y HYDROCO/APAP TAB 5-325MG $0.00 Y

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Schedules and Rates

(4 days ago) Pharmacy providers are paid as described in OAC rules 5160-9-05 (drugs including influenza vaccine) and 5160-9-02 (supplies). Visit Ohio Medicaid Pharmacy website for a searchable database of pharmacy coverage and rates.

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Frequently Asked Questions 340B Drug Pricing Program

(Just Now) Prescribed drugs purchased through the 340B drug discount pricing program are not eligible for Medicaid drug rebates. ODM has developed the following practices to assist 340B covered entities (CE) in their obligation to avoid duplicate discounts. Does Ohio Medicaid seek drug rebates under the Medicaid Drug Rebate Program for

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Ohio Department of Medicaid (ODM) Pharmacy & …

(2 days ago) drugs within a class or classes of prescribed drugs serves as the primary basis in rendering objective decisions about drugs being considered for coverage by Ohio Medicaid. Definition: A potential “conflict of interest” may exist when a committee member has a relationship with

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Unified Preferred Drug List

(8 days ago) The Statewide PDL is not an all-inclusive list of drugs covered by Ohio Department of Medicaid. Medications that are new to market will be non-preferred until reviewed by Ohio Department of Medicaid's Pharmacy and Therapeutics Committee. The list is set up in sections defined by therapeutic class. Products are listed by generic name if the generic

Category:  Medications,  Pharmacy Go Now


OAC 5160-9-12 List of Drugs Covered Without Prior

(6 days ago) List of Drugs Covered Without Prior Authorization. Drug Name CoPay Covered for Dual Eligible ANALGESICS - OPIOID METHADONE CON 10MG/ML $0.00 Y METHADONE SOL 10MG/5ML $0.00 Y METHADONE SOL 5MG/5ML $0.00 Y METHADOSE CON 10MG/ML $2.00 Y METHADOSE SF CON 10MG/ML $2.00 Y

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Preferred Drug List

(Just Now) Ohio Medicaid PDL effective January 1, 2020 Page 1 Ohio Medicaid Pharmacy Benefit Management Program Preferred Drug List Unified Preferred Drug List

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Unified Preferred Drug List (UPDL) Changes

(8 days ago) NEW NON-PREFERRED DRUGS THERAPEUTIC CLASS PA REQUIRED NON-PREFERRED Analgesic Agents: Non -Gastroprotective NSAIDS FENOPROFEN KETOPROFEN NAPRELAN (naproxen) NAPROXEN CR, DR NAPROXEN SUSP (PA required age >12) TOLMETIN Analgesic Agents: NSAIDS Transdermal/Topical DICLOFENAC 1.3% patch (generic of Flector patch)

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Preferred Drug List

(3 days ago) STEP THERAPY: Short-acting drugs 1. Short-acting, single entity, CII tablets/capsules require previous utilization of at least one combination product or tramadol, for no less than one week 2. For a non-preferred drug, there must have been inadequate clinical response to preferred

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Ohio Department of Medicaid Pharmacy & Therapeutics

(3 days ago) the Medicaid Director drugs that should be included on the PDL. The Committee’s recommendations shall be made based on the evaluation of competent evidence regarding the relative safety, efficacy, and effectiveness of prescribed drugs within a class or classes of prescribed drugs. A vote by a majority of a

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Ohio Department of Medicaid

(3 days ago) A Dispensing fees shown are for non‐compounded drugs. See Ohio Administrative Code 5160‐9‐05(E)(1)(b) Table 1.3 includes the average cost of dispensing for pharmacies based on the current survey using the volume tiers currently used by ODM as the basis for professional dispensing fees for non-compounded drugs.

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Pharmacy Billing Information pharmacy.medicaid.ohio.gov

(3 days ago) Pharmacy Billing Information. Pharmacy claims are processed by ODM’s contracted pharmacy benefits manager (PBM) in an online, real-time environment which allows the dispensing pharmacist access to the terms of coverage. The capabilities of the system include response messaging which …

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The Bulletin of Medicaid Drug Utilization Review (DUR) in

(1 days ago) For non-preferred drugs without medication specific criteria, there must have been an inadequate clinical response to preferred alternatives, including a trial of no less than 30 days each of at least two preferred products . PRIOR AUTHORIZATION CRITERIA: Sunosi (soriamfetol)

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Preferred Drug List

(2 days ago) STEP THERAPY: Long-acting drugs 1) For a preferred brand, there must have been inadequate clinical response to preferred generic alternatives, including a trial of no less than one week of at least one preferred generic 2) For a non-preferred drug, there must have been inadequate clinical response to …

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Preferred Drug List

(4 days ago) Ohio Medicaid PDL effective January 1, 2018 Page 1 Ohio Medicaid Fee-For-Service Pharmacy Benefit Management Program Preferred Drug List Effective January 1, 2018

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Pharmacy Services Table of Contents

(2 days ago) Ohio Administrative Code rule 5160-9-12, "Ohio Department of Medicaid list of drugs covered without prior authorization" has been amended to support this initiative. This rule has been amended to update the list to reflect the new PDL, as well as delete coverage for drugs no longer covered by Medicaid and add drugs that are new to the market.

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OAC 5160-9-12 List of Drugs Covered Without Prior

(5 days ago) list of drugs covered without prior authorization ibu tab 800mg $0.00 n ibuprofen pow $0.00 n ibuprofen sus 100/5ml $0.00 n ibuprofen tab 400mg $0.00 n ibuprofen tab 600mg $0.00 n ibuprofen tab 800mg $0.00 n indocin sup 50mg $2.00 n indocin sus 25mg/5ml $2.00 n indomethacin cap 25mg $0.00 n indomethacin cap 50mg $0.00 n

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Ohio Department of Medicaid Pharmacy & Therapeutics

(4 days ago) prescribed drugs within a class or classes of prescribed drugs. 2) Apply their knowledge of current clinical practice during discussions and the making of recommendations. 3) Attend and participate in all Committee meetings, unless they are excused for good cause …

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Preferred Drug List

(6 days ago) STEP THERAPY: Long-acting drugs 1. For a preferred brand, there must have been inadequate clinical response to preferred generic alternatives, including a trial of no less than one week of at least one preferred generic 2. For a non-preferred drug, there must have been inadequate clinical response to …

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PROFESSIONAL DISPENSING FEE ANALYSIS FOR MEDICAID …

(8 days ago) methodologies for prescription drugs. Under the final rule, states must reimburse covered outpatient drugs at actual acquisition cost plus a professional dispensing fee for drugs dispensed in Retail Community pharmacies and 340B enrolled pharmacies that carve-in Medicaid. The regulation requires all states to be in compliance with the reimbursement

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Unified Preferred Drug List (UPDL)

(6 days ago) Unified Preferred Drug List (UPDL) Buckeye Health Plan | CareSource | Molina Healthcare | Paramount Advantage | UnitedHealthcare October 1, 2019

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Pharmacy Provider Manual Billing Procedure Guide

(1 days ago) • [3.2] Added additional drugs to 102-day supply • [3.2] Added information regarding Medication Synchronization (Med Sync) 3/24/2017 •4/1/2017 3.3 Provider's Dispensing Fees 3.5 Drug Coverage 3.9 Long Term Care (LTC) Claims 3.16 Influenza Vaccine Administration 3.20 340(B) 6.1 …

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Pharmacy & Therapeutics (P&T) Committee pharmacy

(6 days ago) Pharmacy & Therapeutics (P&T) Committee. The Pharmacy and Therapeutics (P&T) Committee is responsible for developing and maintaining medications and related products listed on the Ohio Department of Medicaid’s (ODM) Unified Preferred Drug List (UPDL) pursuant to the Ohio Revised Code § 5164.7510. The UPDL is maintained through a review of

Category:  Medications,  Pharmacy Go Now


OHIO DEPARTMENT OF MEDICAID Prior Authorization Form

(5 days ago) Begin the list with the covered legend drugs. Please attach an additional form if compound has greater than 10 ingredients. DRUG NAME DOSAGE FORM QTY Clinical Criteria: 1. Please provide the diagnosis the compound is intended to treat: _____ 2. Please provide …

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OHIO MEDICAID NCPDP VERSION D.Ø PAYER SHEET

(9 days ago) R Must be Ø for Schedule II drugs. Refill 1-99 allowed for Long Term Care Schedule II drug with a partial fill. 4Ø5-D5 DAYS SUPPLY R 4Ø6-D6 COMPOUND CODE 1=Not a Compound 2=Compound R 4Ø8-D8 DISPENSE AS WRITTEN (DAW)/PRODUCT SELECTION CODE R 414-DE DATE PRESCRIPTION WRITTEN R Date written must be within 6 months of

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Pharmacy Provider Manual Billing Procedure Guide

(7 days ago) Drugs 3.14 Qualified Medicare Beneficiary (QMB) 3.20 Miscellaneous Appendix A Prior Authorization Forms •[3.1] Added language regarding Presumptive Eligibility • [3.2] Added policy regarding PRN dosing on prescriptions • [3.3] Added notification of rejection/PA requirement for high cost compounds

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Unified Preferred Drug List (UPDL) Unified Preferred Drug List

(2 days ago) of drugs October 3, 2019 Final plan meeting to present full set of shift assumptions for all drugs October 9, 2019 Plans begin testing technical file with DXC – testing will be on-going until file transfer is successful Early to mid October, 2019 Readiness Review Tool (RRT) sent to Plans

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Medicaid pharmacy reimbursement stakeholder meeting

(9 days ago) Federal Covered Outpatient Drugs final rule –February 1, 2016. Effective April 1, 2017, ODM will be changing its covered outpatient drug reimbursement methodology to comply with the federal rule • Ingredient cost reimbursement will move from estimated acquisition cost (EAC) to actual

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Unified Preferred Drug List (UPDL) Adherence Methodology

(Just Now) The following drugs and therapeutic categories will be monitored for adherence and compliance may be issued if the MCP does not meet the expected level of adherence. Required MCP adherence was calculated using utilization data and shift assumptions provided by …

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NEW PREFERRED DRUGS

(1 days ago) NEW PREFERRED DRUGS THERAPEUTIC CLASS NO PA REQUIRED PREFERRED Central Nervous System (CNS) Agents: Anticonvulsants VALTOCO® (diazepam) NEW CLINICAL PA REQUIRED “PREFERRED” DRUGS THERAPEUTIC CLASS CLINICAL PA REQUIRED PREFERRED Blood Formation, Coagulation, and Thrombosis Agents: Colony Stimulating Factors ZIEXTENZO™ …

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The Bulletin of Medicaid Drug Utilization

(8 days ago) Top 5 Drugs by Paid Amount (pre-rebate) Lantus Inj Solostar & Vial Sabril 500mg Powder & Tablets Spiriva Handihaler Novolog FlexPen & Vial Invega Sustenna 234/1.5 Top 5 Drugs by Claim Count Loratadine Tablet 10mg Vitamin D Capsule 50,000 Unit Ferrous Sulfate Tablet 325mg Folic Acid Tablet 1mg Calcium with Vitamin D 500mg Tablet Top 5 Therapeutic

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Pharmacy Benefit Management Program

(2 days ago) Ohio Medicaid Unified PDL effective January 1, 2020 Page 1 Ohio Medicaid Pharmacy Benefit Management Program Unified Preferred Drug List Medicaid Fee-for-Service and Managed Care Plans

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NEW PREFERRED DRUGS

(3 days ago) Preferred Drug List (PDL) Changes P&T Meeting Date: October 4, 2017 PDL Changes Effective Date: January 1, 2018 Date of Notice: 12/01/2017 Page 2 of 5 NEW NON-PREFERRED DRUGS

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Pharmacy Provider Manual Billing Procedure Guide

(9 days ago) Covered Drugs • [3.20] Added policies for test claims and discount cards • [Appendix A] Prior Authorization Forms updated 9/17/20 •9/21/20 3.2 Dispensing Limits Appendix A Prior Authorization Forms [3.2] Added language regarding CII prescriptions must have quantity greater than zero populated in the NCPDP Quantity Prescribed Field (460-ET).

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Pharmacy Provider Manual Billing Procedure Guide

(6 days ago) [3.2] Added additional drugs to 102-day supply [3.2] Added information regarding Medication Synchronization (Med Sync) 3/24/2017 4/1/2017 3.3 Provider's Dispensing Fees 3.5 Drug Coverage 3.9 Long Term Care (LTC) Claims 3.16 Influenza Vaccine Administration 3.20 340(B) 6.1 …

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Preferred Drug List (PDL) Changes

(6 days ago) Preferred Drug List (PDL) Changes P&T Meeting Date: July 10th, 2019 PDL Changes Effective Date: October 1st, 2019 Date of Notice: 09/04/2019 Page 1 of 4 NEW PREFERRED DRUGS THERAPEUTIC CLASS CLINICAL PA REQUIRED “PREFERRED STATUS” …

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Preferred Drug List (PDL) Changes

(8 days ago) Preferred Drug List (PDL) Changes P&T Meeting Date: October 3rd, 2018 PDL Changes Effective Date: January 1st, 2019 Date of Notice: 11/30/2018 Page 1 of 1 NEW PREFERRED DRUGS

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Prior Authorization (PA) Information pharmacy.medicaid

(4 days ago) Prior authorization (PA) is the process of obtaining additional information from the prescriber of a procedure, medication or service for the purpose of ensuring eligibility, benefit coverage, medical necessity, location and appropriateness of services. This tool is used by ODM to ensure safety of our beneficiaries and to help control costs.

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Preferred Drug List (PDL) Changes

(8 days ago) NEW PREFERRED DRUGS THERAPEUTIC CLASS RECOMMENDED for PREFERRED STATUS Infectious Disease Agents: Antivirals – Hepatitis C Agents VIEKIRA XR™ (clinical criteria applies) Respiratory Agents: Beta-Adrenergic Agonists – Inhaled, …

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Prior Authorization (PA) and Step Therapy Frequently Asked

(8 days ago) Following introduction to the market, new drugs, new formulations or indications of existing drugs, generally require PA until the Pharmacy and Therapeutics Committee complete a review of the product. Requests for PA will be handled for these drugs either within the existing categories (if available) or in accordance with FDA-approved labeling. 5.

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Introduction to Change Healthcare 2020 Change Healthcare

(1 days ago) antipsychotic class of drugs include weight gain, glucose intolerance or diabetes, dyslipidemia, and hypertension. 6. Baseline screening and regular monitoring of patients should be performed. Patients taking atypical antipsychotics should have fasting plasma glucose or HbA1C testing, fasting lipid profiles, weight, and blood pressure measured. 7

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