pharmacy.medicaid.ohio.gov
Drug Coverage Information | ohpbm.dev
http://pharmacy.medicaid.ohio.gov/drug-coverage
Drug Look Up Tool. A list of medications available without a prior authorization is available here. In compliance with OAC 5160-9-12. The Preferred Drug List (PDL) ( DOWNLOAD CURRENT LIST. DOWNLOAD LIST EFFECTIVE 4/1/2017. Additional Therapeutic Classes with Clinical Criteria ( DOWNLOAD. Quantity Limits ( DOWNLOAD. Covered Active Pharmaceutical Ingredients and Excipients for Compounding ( DOWNLOAD. Drug Look Up Tool. 2016 Ohio Department of Medicaid.
pharmacy.medicaid.ohio.gov
Pharmacy Billing Information | ohpbm.dev
http://pharmacy.medicaid.ohio.gov/pharmacy-billing-information
Drug Look Up Tool. Pharmacy claims are processed by ODM’s contracted pharmacy benefits manager (PBM) in an online, real-time environment which allows the dispensing pharmacist access to the terms of coverage. The capabilities of the system include response messaging which may help in claims processing. Both the pharmacy and prescriber National Provider Identifier (NPI) are required on all POS and paper claims submissions. Claims submitted with a service provider ID other than NPI will be reje...For assis...
pharmacy.medicaid.ohio.gov
Drug Utilization Review (DUR) Board | ohpbm.dev
http://pharmacy.medicaid.ohio.gov/drug-utilization-review-board
Drug Look Up Tool. DUR Board Meeting Minute Archive. Drug Utilization Review (DUR) Board. The Ohio Drug Utilization Review (DUR) program is a provider-oriented, educational outreach program designed to alert physicians and pharmacists to inappropriate or medically unnecessary care. The purpose of the program is to safeguard the health of Medicaid consumers, to assess the appropriateness of drug therapy, and to reduce the frequency of fraud, abuse and gross overuse. The Three Phases Of DUR. Retrospective ...
pharmacy.medicaid.ohio.gov
News | ohpbm.dev
http://pharmacy.medicaid.ohio.gov/news
Drug Look Up Tool. The results of the 2016 Professional Dispensing Fee Survey. And information on the 2017 Pricing Methodology Changes. Following the P&T meeting, ODM accepted the recommendations of the committee regarding drug placement in preferred and non-preferred positions. The recommendations will be implemented January 1, 2017. The recommendations regarding clinical criteria are under review and will be discussed at a future meeting. DUR Board Meeting on November 15, 2016 has been cancelled.
pharmacy.medicaid.ohio.gov
Archive | ohpbm.dev
http://pharmacy.medicaid.ohio.gov/archive
Drug Look Up Tool. The archive contains links and information on historic program features. P&T Meeting Minute Archive. 2016 Ohio Department of Medicaid.
pharmacy.medicaid.ohio.gov
Site Map | ohpbm.dev
http://pharmacy.medicaid.ohio.gov/sitemap
Drug Look Up Tool. Drug Look Up Tool. PA Criteria Update History. P&T Meeting Minute Archive. DUR Board Meeting Minute Archive. 2016 Ohio Department of Medicaid.
pharmacy.medicaid.ohio.gov
Pharmacy Claims Review | ohpbm.dev
http://pharmacy.medicaid.ohio.gov/pharmacy-claims-review
Drug Look Up Tool. Claims review satisfies the federal requirements to help protect against fraud, waste, and abuse (FWA). Additionally, claims review provides pharmacies education in correct billing practices. Any paid claims that do not fully comply with all requirements or ODM FFS policies are subject to recoupment. For additional claims review information, refer to the ODM Pharmacy Claims Review Provider Manual. 2016 Ohio Department of Medicaid.
pharmacy.medicaid.ohio.gov
Prior Authorization (PA) Information | ohpbm.dev
http://pharmacy.medicaid.ohio.gov/prior-authorization
Drug Look Up Tool. PA Criteria Update History. Prior Authorization (PA) Information. Prior authorization (PA) is the process of obtaining additional information from the prescriber of a procedure, medication or service for the purpose of ensuring eligibility, benefit coverage, medical necessity, location and appropriateness of services. This tool is used by ODM to ensure safety of our beneficiaries and to help control costs. Standard Prior Authorization form. Suboxone/Zubsolv Prior Authorization form.
pharmacy.medicaid.ohio.gov
Pharmacy & Therapeutics (P&T) Committee | ohpbm.dev
http://pharmacy.medicaid.ohio.gov/pharmacy-therapeutics-committee
Drug Look Up Tool. P&T Meeting Minute Archive. Pharmacy and Therapeutics (P&T) Committee. The P&T Committee is composed of ten members appointed by the Medicaid Director. The P&T Committee members meet four times per year-including an annual review of the entire PDL. Topics that may be discussed at meetings include:. New brand or generic drugs. PDL changes based on any local or national issues (including contract issues). Stakeholder feedback through a Public Comment session. Meeting Schedule and Minutes.
