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:

Phone

Phone:  833-491-0344
8 a.m. to 8 p.m. EST Monday to Friday

OH_Fax_Icon

Fax:  833-679-5491

OH_Mail_Icon

Mail: Gainwell Technologies OH SPBM,
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)

OH_Fax_Icon

Fax: 800-563-5581

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

Join our network

We’re glad you’re interested in joining the Anthem network. We have a diverse network of exceptional healthcare professionals who ensure our members have uninterrupted access to the support they need.