Ohio Medicaid launches innovative pharmacy benefit and simplified provider credentialing in its phased Next Generation managed care implementation Rollout introduces a new era of pharmacy transparency with the single PBM, and eases provider administration to better serve members September 30, 2022

Summary

Ohio Medicaid launched a single pharmacy benefit manager (SPBM) operated by Gainwell Technologies on October 1, 2022, replacing MCO-embedded pharmacy programs for the state's approximately $4 billion Medicaid medication benefit, and simultaneously introduced centralized provider credentialing through a new Provider Network Management system. The SPBM provides members access to more than 2,600 pharmacy locations with evidence-based, transparent reimbursement rates and expands specialty pharmacy choice. A third phase of Ohio Medicaid's Next Generation overhaul, introducing seven new managed care organizations, was set for December 1, 2022.