Ohio Medicaid has eased several pharmacy benefit restrictions
Governor DeWine announced that Medicaid, the managed care plans, and MyCare Ohio plans have come together to remove barriers for members receiving Medicaid benefits during this crisis.
"These groups have collaborated to maintain the health of individuals to keep them out of the hospital and reduce undue strain on our healthcare system," said Governor DeWine. "They are trying to reduce the administrative requirements of physicians and others in order to give them more flexibility so that they can focus on safe patient care."
Medicaid has eased several pharmacy benefit restrictions.
- Prior authorizations will be by-passed for new prescriptions.
- Members will receive pharmacy benefits regardless of in-network or out-of-network provider status.
- The threshold for refills on certain prescriptions will be relaxed.
- Pharmacists who dispense emergency refills without a prescription will be reimbursed.
- Pharmacies that dispense over-the-counter medications without a prescription will be reimbursed.
- Member co-pays will be waived for all prescriptions.
- 90-day supplies on maintenance medications will be authorized.
The managed care plans have already lifted prior authorizations for all but a few services. This took effect on March 27. Physicians and other providers, without prior authorization by a managed care plan, are using clinical judgment to determine if something is a medical necessity.
More details will be available on coronavirus.ohio.gov or by calling the COVID-19 Call Center at 1-833-4-ASK-ODH.