The Ohio Medicaid Drug Program
The Ohio Medicaid Drug program is a federal and state supported program that provides prescription drug coverage to eligible consumers. ODJFS administers the program which presently encompasses over 30,000 line items of drugs from nearly 300 different therapeutic categories. Pharmacy claims are processed by ACS State Healthcare in an online, real-time environment which allows the dispensing pharmacist access to the terms of coverage. In the event a particular drug is not approved, the dispensing pharmacist can notify the prescribing physician of possible alternatives in a timely fashion. The prescribing physician may choose an alternative product or may call a designated toll-free number to request prior authorization (PA) for the product originally prescribed.
ODJFS has implemented a Preferred Drug List (PDL) to ensure quality patient care while maintaining a financially responsible program. Additional PDL information is provided below.
Important Links:
- Ohio Medicaid Approved Drug List - Database of drugs covered without PA
- Quick Drug List - Drugs covered without PA for select therapeutic classes
- Approved Drug List Updates - List of additions, deletions and changes to the drugs covered without PA
- Point-Of-Sale Pharmacy Claims Submission Information and Provider Manual - Proper processing of pharmacy claims, including a form that may be completed by the prescribing physician when requesting PA
- Pharmacy and Therapeutics Committee Information - Committee members, meeting dates and the PDL
- Drug Utilization Review (DUR) - The Ohio DUR program is a provider-oriented, educational out-reach program designed to alert physicians and pharmacists on inappropriate or medically unnecessary pharmacological care.
- OTC drugs for nursing facility residents.
- Influenza Vaccine Administered at the Pharmacy
- Drugs Requiring Prior Authorization - Effective October 1, 2011
- Pharmacy Information for Managed Care Plan Members
Disclaimer: Beginning October 1, 2011, prescription drug coverage for members of Medicaid Managed Care Plans (MCPs) is the responsibility of the MCP and the information available on this page will not apply to MCP enrollees. Prescription drug claims for MCP enrollees should be directed to the MCP’s Pharmacy Benefit Manager. Pharmacy benefit information is available on the MCP websites. For more information about Medicaid managed health care plans, please refer to the last bullet above for MCP Pharmacy billing information and visit Managed Care's Web page.