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Ohio Department of Medicaid · June 26, 2025 · Primary source

ODM Talks Single Pharmacy Benefit Manager at JMOC SPBM provides pharmacy services across all Ohio Medicaid managed care plans and members. June 26, 2025

Score 75PRIMARYregulatoryState MedicaidOH

Summary

Ohio Department of Medicaid Director Maureen Corcoran testified before the Joint Medicaid Oversight Committee on June 26, 2025, presenting the results and structure of Ohio's Single Pharmacy Benefit Manager program, which provides pharmacy services to all Ohio Medicaid members across all managed care plans and fee-for-service. The SPBM eliminated spread pricing and replaced it with a survey-based Ohio Average Acquisition Cost methodology, with an average dispensing fee of over $9 per prescription compared to 73 cents under the prior model. The program reported $140 million in total savings and $333 million in administrative savings over its first two years, with over 99 percent of Ohio pharmacies contracted into the network.

What this may mean

The SPBM restructures pharmacy reimbursement for all Ohio Medicaid managed care organizations and participating pharmacies, replacing spread pricing and effective rate contracting with a publicly transparent acquisition-cost and dispensing-fee methodology. Pharmacies in Ohio Medicaid receive dispensing fees averaging over $9 per prescription, a material increase from the prior model, affecting revenue calculations for more than 2,300 Ohio pharmacies. The model is being cited by the American Pharmacists Association to the Trump administration as a candidate for national adoption, signaling potential federal policy relevance.

Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.

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