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Welcome to
Ohio Medicaid
Pharmacy Services
Supported by Gainwell Pharmacy Services.
09/01/2024
Effective 09.01.2024, the medications below will require a prior authorization (submitted by your prescriber) if there is not already an active prior authorization on file:
- Bydureon Bcise (exenatide)
- Mounjaro (tirzepatide)
- Ozempic (semaglutide)
- Rybelsus (semaglutide)
Prescribers may submit a prior authorization by electronic request, by faxing Gainwell Pharmacy Services at 833-679-5491, or by calling 833-491-0344 (TTY 833-655-2437). Prior authorizations are processed within 24 hours of receipt.
Prior authorization submissions for the medications above will be reviewed per the Ohio Medicaid Unified Preferred Drug List (UPDL) clinical criteria. You can find more information about prior authorizations for these medications by visiting https:\\spbm.medicaid.ohio.gov. Choose “Reference Material", then “Unified Preferred Drug List", and then “UPDL criteria effective 07.01.2024" from the list of documents.
06/30/2023
Beginning on July 1, 2023, in addition to Ohio Medicaid Managed Care, Gainwell Technologies will be the Single Pharmacy Benefit Manager (SPBM) for Ohio Medicaid Fee for Service. ODM's continued goal for the SPBM are to improve management and administration of pharmacy benefits for Ohio Medicaid managed care members. Through the SPBM, ODM gains increased accountability and ensures alignment with clinical and policy goals, while also improving transparency.
A Frequently Asked Questions (FAQ) for pharmacies servicing FFS members is available here: SPBM FFS Provider FAQ
06/30/2023
Are you a pharmacy or prescriber having issues registering for the secure SPBM Web Portal? Gainwell is offering several options available below for your assistance:
- Single Pharmacy Benefit Manager (SPBM) Secure Web Portal Provider Registration FAQ is available here.
- Provider Registration Manual is available here.
- Provider Registration Process training video is available here.
06/30/2023
The SPBM Web Portal training recording is now available for all enrolled Ohio Medicaid Members!
For Member training registration instructions, click here.
If you have any questions regarding SPBM Web Portal training, please email OH_MCD_PBM@gainwelltechnologies.com
06/30/2023
Pharmacy Web Portal training recording now available
The recorded SPBM Web Portal training is now available for pharmacies and pharmacy support staff. Viewing this training is important for pharmacists and their support staff to learn about the many tools available on both the public facing and secure portal. The public facing portal includes access to reference material such as the Unified Preferred Drug List and criteria. The secure portal requires log in credentials. It provides access to specific patient information and the ability to reach the SPBM Clinical help desk via web chat. SPBM Clinical staff can also be reached via phone and email.
To access the recording, please click here. Please use the same Learning Management System (LMS) credentials set up during your registration to log in.
Prescriber Web Portal training recording now available
The recorded SPBM Web Portal training is now available for prescribers and prescriber support staff. Viewing this training is important for pharmacists and their support staff to learn about the many tools available on both the public facing and secure portal. The public facing portal includes access to reference material such as the Unified Preferred Drug List and criteria. The secure portal requires log in credentials. It provides access to specific patient information and the ability to reach the SPBM Clinical help desk via web chat. SPBM Clinical staff can also be reached via phone and email.
To access the recording, please click here. Please use the same Learning Management System (LMS) credentials set up during your registration to log in.
12/27/2022
Ohio SPBM Prescribers, When submitting a prior authorization (PA) request via fax or mail, the prescriber is required to use the prior authorization forms found on the SPBM portal and must include the member's 12-digit Medicaid ID (also known as the “Member ID" on the member's ID card) in the document header. Failure to do so will not allow the system to appropriately associate the authorization with the member. Starting 2/10/2023, Gainwell Technologies SPBM will no longer accept PAs without the correct 12-digit Medicaid ID. Please direct questions to Gainwell Technologies Help Desk at 833-491-0344.
10/01/2022
Gainwell Technologies and the Ohio Department of Medicaid (ODM) launched the Single Pharmacy Benefit Manager (SPBM) on October 1! Gainwell has already contracted with more than 2600 pharmacies. ODM's goals for the SPBM are to improve management and administration of pharmacy benefits for Ohio Medicaid managed care members. Through the SPBM, ODM gains increased accountability and ensures alignment with clinical and policy goals, while also improving transparency.
Questions?
Pharmacy providers and members may contact the Gainwell Customer Support Center by phone 833-491-0344, 24 hours a day, seven days a week. The Customer Support Center is closed on Thanksgiving Day and Christmas.
Managed Care Entity Web Portal training recording now available
The recorded SPBM Web Portal training is now available for Managed Care Entity Portal Administrators and staff. Viewing this training is important for managed care entities to learn about the many tools available on both the public facing and secure portal. The public facing portal includes access to reference material such as the Unified Preferred Drug List and criteria. The secure portal requires log in credentials that will allow access to specific patient information. The portal also gives the user the ability to reach the SPBM Clinical help desk via web chat.
To access the recording, please click here . Please use the same Learning Management System (LMS) credentials set up during your registration to log in.
05/01/2022
Welcome to the new Ohio Medicaid pharmacy services online portal.
This is a soft launch of the SPBM online portal with limited features.
Thank you for your patience as we continue to enhance the system.
- General
- Member
- Provider
- MCE
Welcome to Ohio Medicaid Pharmacy Services Online Portal
This website provides information to members, pharmacies, prescribers, Managed Care Entities, and the public. Users may find helpful website links and documents within our online portal in the menu bar above.
Members
Log in to the member secure portal to view your:
- Medicaid claims and notifications
- Medicaid programs and benefits
- Directory of providers
Providers / Trading Partners
Login to the provider secure portal to:
- View Medicaid eligibility and history
- Submit claims
- Submit authorization requests
- Check document status
- Resume provider enrollment application
- Check provider enrollment application status
- How to Apply for Medicaid
- Medicaid Card Information
- Medicaid Member Handbook
- Specialty Pharmacy Directory
- Privacy Practices
- Member SPBM Web Portal Training
- Member Pharmacy FAQs
You may apply for Medicaid benefits by:
Gainwell Pharmacy Services
5475 Rings Rd.
Atrium II North Tower, Suite 125
Dublin, Ohio 43017-7565
OH_MCD_PBM@GainwellTechnologies.com
- Going to Ohio Benefits
- You can also call or visit your local county office for help with benefits at 1-844-640-OHIO (6446). TTY: 711
Gainwell Pharmacy Services
5475 Rings Rd.
Atrium II North Tower, Suite 125
Dublin, Ohio 43017-7565
OH_MCD_PBM@GainwellTechnologies.com
If you are enrolled in Managed Care, you will receive a card from your managed care plan.
You can access the Member Handbook here.
Your guide to Medicaid and other information about your Medicaid benefits can be found in the Member section of the Medicaid Managed Care Plan websites.
The Specialty Accredited Pharmacy Lists are available here.
The Gainwell Notice of Privacy Practices is available here.
Register today for SPBM Web Portal training!
Registration for SPBM Web Portal training is now open for all members.
Please join the Gainwell Ohio SPBM training staff to learn the difference between the public and the secure portals, including how to register for the secure portal. During the training, you will also learn about many exciting tools available on the SPBM Web Portal such as member eligibility, viewing prior authorization status, the ability to quickly speak with the SPBM help desk, and much more!
Members will have access to a training video on Oct. 1. For training registration instructions, click here.
The Member Pharmacy FAQs is available here.
- Portal Registration
- Provider Enrollment and Contracting
- Pharmacy Billing Information
- Specialty Pharmacy Directory
- Provider Manual
Any provider (prescriber or pharmacy) that wishes to use the Portal to exchange PHI will be required to register as a trading partner. Pharmacies and prescribing providers must be enrolled with Ohio Medicaid prior to registering as a trading partner. Trading partner account registration/activation enables access to the secure provider portal for direct data entry of claims and prior authorizations, member eligibility inquiries, claim status inquiries, remittance advice, and more. Registration will begin Fall 2022.
Before beginning the enrollment or re-enrollment process, gather all information needed to complete an application. A detailed description of how to complete each of the enrollment steps and a list of information to have on hand before starting the enrollment application is available at: Provider Enrollment.
The Provider Network Management (PNM) module is going live in parallel with the Single Pharmacy Benefit Manager (SPBM) on Oct. 1. PNM will replace MITS provider enrollment and provider data management. This launch also includes a new requirement to establish an OH|ID to access any of ODM's Ohio Medicaid Enterprise Systems (OMES).
To allow providers an advanced opportunity to set up their OH|ID and associate their accounts, ODM has launched a PNM pre-registration site at: https://pnm-preregistration.omes.maximus.com. The PNM Pre-Registration tool is available until Sept. 23 and will ease the transition and prevent disruptions to system access for providers ahead of go-live on Oct. 1. Additionally, PNM training is now available for providers in a variety of formats, including virtual, in-person, and self-paced. Please access this job aid for step-by-step instructions to sign up for a session.
The Specialty Accredited Pharmacy Lists are available here.
The Provider Manual, also known as the Pharmacy Reference Guide, is available here.
- MCE
Managed Care Entities (MCE) including Managed Care Organizations (MCO) and the Prepaid Inpatient Health Plan (PIHP), which is also known as OhioRISE, will be given access to the SPBM online portal to view clinical profile information about members that are actively enrolled in their associated MCE.
Clinical information that is available includes member benefit and eligibility, pharmacy prescription claims activity, Rx prior authorizations, and Coordinated Services Program (CSP) status will be distributed to the MCEs, however, the portal will allow quicker access to the most current information.