Pharmacy information
Pharmacy information for Medicaid
NOTE: For direction related to the MyCare Ohio plan, please refer to the “Pharmacy information for MyCare Ohio” section on this page.
Pharmacy benefits for enrolled members are managed through the Ohio Department of Medicaid (ODM). ODM has contracted with a single pharmacy benefit manager (SPBM) to improve the administration of pharmacy benefits for managed care recipients and ensure transparency, accountability, and integrity to better serve Ohio Medicaid members and their healthcare providers. The SPBM consolidates the processing of retail pharmacy benefits and maintains a pharmacy claims system that integrates with the Ohio Medicaid Enterprise System (OMES), new MCOs, pharmacies, and prescribers.
Please refer to the Preferred Drug List (PDL) when prescribing for our Medicaid members. This guide does not contain a complete list of drugs; rather, it lists the preferred drugs within the most commonly prescribed therapeutic categories.
Though most medications on the PDL are covered without prior authorization, a few agents will require you to contact our Pharmacy Department for authorization.
Single pharmacy benefit manager (SPBM) for Medicaid providers
The SPBM provides more pharmacy choices for members and offers a more streamlined process for providers with a single Preferred Drug List and uniform clinical criteria for coverage. SPBM services include:
- Processing pharmacy claims for all covered drugs dispensed by any pharmacy provider
- Providing expert clinical knowledge to establish Preferred Drug Lists (PDLs)
- Contracting with pharmacies to ensure members have easier access to medications
SPBM resources
SPBM contact information
Prior authorizations can be submitted by phone, fax, or mail:
8 a.m. to 8 p.m. EST Monday to Friday
P.O. Box 3908 Dublin, OH 43016-0472;
Medical injectables for Medicaid providers
Provider administered drugs can be accessed via fax. The information presented in the provider administered pharmaceuticals fee schedule and prior authorization submission through fax pertains to medical drugs only when the provider plans to buy & bill.
Access provider administered drugs (buy & bill)
Fax: 800-563-5581
Provider Administered Pharmaceuticals Fee Schedule
Medical Injectable resources
Pharmacy information for MyCare Ohio
Please refer to the formulary when prescribing for MyCare Ohio members. Though most medications on the formulary are covered without prior authorization, a few agents will require you to obtain an authorization.
For Medicare Part B, contact:
Provider Services
833-727-2170
Ohiomedicaidprovider@anthem.com
For Medicare Part D, contact:
CarelonRX Provider Services
1-833-293-0659
MyCare Ohio Coverage Determinations
Providers can send a request for a prescription coverage determination for a MyCare Ohio plan via electronic prior authorization (ePA) rather than fax or phone by submitting the request from CoverMyMeds or SureScripts.
Provider tools & resources
- Log in to Availity Essentials
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Provider Manuals and Guides
- Provider Search Tool
- Forms
- Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)