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Pharmacy

At Buckeye Health Plan it is important that our members receive drug therapy that is appropriate, high quality and cost effective. We work closely with the Single Pharmacy Benefit Manager-Gainwell Technologies to ensure you have access to safe and effective medications that are medically proven to help you get healthy and stay healthy.

Clinical Programs and Medication Adherence

Buckeye Health Plan offers tailored clinical programs that are customized to drive medication adherence and reduce medication errors. These programs are designed to improve health outcomes by supporting members in managing chronic conditions and ensuring they receive the right medications at the right time to get and stay healthy.             

Medication Therapy Management (MTM): Our MTM programs support members in understanding and managing their medications, helping to optimize their health regimens and improve therapeutic outcomes.

Single Pharmacy Benefit Manager (SPBM)

In 2019, the Ohio Legislature directed ODM to make a shift in the Medicaid pharmacy program and select and contract with a single pharmacy benefit manager (PBM). ODM’s goals for the single pharmacy benefit manager (SPBM) are to improve management and administration of pharmacy benefits for managed care recipients. Through SPBM, ODM will gain increased financial accountability and ensure alignment with our clinical and policy goals, while also improving transparency. ODM selected Gainwell Technologies as the SPBM for Ohio Medicaid.

On October 1, 2022, the SPBM will begin providing pharmacy services across all managed care plans and members. Until the SPBM goes live on October 1, 2022, there is no change to the current process for submitting pharmacy claims or pharmacy prior authorizations. Through SPBM, pharmacists and prescribers will see benefits from streamlining and consolidation of processes currently provided by multiple, individually contracted PBMs. The SPBM will be responsible for maintaining the Unified Preferred Drug List (UPDL), and will also include implementation of a single set of clinical and prior authorization policies and claims process, and provide a standard point of contact, reducing the administrative burden on providers.

For Medicaid managed care members, the SPBM will provide more choice in selecting their pharmacy due to fewer out-of-network restrictions. In addition, members will no longer need to consider pharmacy benefits as a decision-making factor when selecting a managed care plan. The SPBM can also incentivize member-valued services and benefits like home delivery, 90-day refills, and adherence programs. Members may also refer to the Gainwell Technologies portal for more information, or call Gainwell member services at 1-833-491-0344 (TTY 1-833-655-2437).

Unified Preferred Drug List (PDL)

The Preferred Drug List (PDL) is the list of drugs covered by Buckeye Health Plan. The Ohio Department of Medicaid, in partnership with the Medicaid managed care plans (MCPs), has created a unified preferred drug list (UPDL). All Ohio Medicaid MCPs will prefer the same medications and use the same prior authorization criteria for the majority of drug categories. This unified list, of drugs will help you know which drugs are covered with or without prior approval. Prior approval is also called prior authorization. 

You can find a copy of the UPDL in the following locations:

If a prescription drug you take is no longer preferred, you will be notified by your doctor, MCP or pharmacy. You may need to change your current drug(s) or ask your prescriber to submit a prior authorization request to stay on your current drug(s). If you receive a letter in the mail from Buckeye Health Plan, make sure to review the letter carefully. You should discuss this information with your prescriber at your next visit or call your prescriber at your earliest convenience. However, if you go to the pharmacy to refill your prescription before your next visit, you might be told that your drug requires prior authorization. We will work with your prescriber to cover a drug that meets your needs. You will not lose drug coverage. Please note that you will also continue to use the same Medicaid ID.

If you have questions or problems with your prescription, call Buckeye member services by dialing the toll-free number 1-866-246-4358 on your Medicaid ID card.

Through the Unified Preferred Drug List (UPDL), Buckeye Health Plan covers certain prescription drugs and over-the-counter drugs when prescribed by a Buckeye Health Plan provider. The pharmacy program does not cover all drugs. Some require prior authorization. Some drugs have limitations on age, dosage or maximum quantities.

The Unified Preferred Drug List (UPDL) is the list of drugs covered by Buckeye Health Plan. Buckeye Health Plan works with the Ohio Department of Medicaid (ODM), providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered. The UPDL applies to drugs you receive at retail pharmacies. The UPDL is continually evaluated by ODM’s Pharmacy and Therapeutics Committee to promote the appropriate and cost-effective use of medications.

 

Specialty Pharmacy Services

A specialty drug is a prescription drug that needs special handling, administration, or supervising. These are often only ordered through a specialty pharmacy.

What is a Specialty Pharmacy?

A specialty pharmacy provides services and medications needed to treat members with chronic, complex or rare conditions. The medication provided by specialty pharmacies is often considered high-touch or high-cost. The services provided by specialty pharmacies are done by highly trained professionals and are more extensive than regular retail pharmacies offer. Specialty pharmacy services can include clinical help, such as training on how to take medication, and financial support, like applying for copay assistance.

Access to Specialty Medications

You can obtain information on how to locate a pharmacy covered in your network by accessing the Pharmacy Provider Directory online or through logging in to your Gainwell Member Portal. You can request a paper copy of the Pharmacy Provider Directory by calling Member Services toll free at 1-833-491-0344 (TTY 1-833-655-2437).

Fill and Receive Your Prescriptions

You can have your prescriptions filled at a Gainwell network pharmacy. At the pharmacy, you will need to give the pharmacist your prescription and your Buckeye Health Plan ID Card.

To find a pharmacy that is in the Gainwell network, you can use the Find a Provider Tool on the Gainwell portal. Type in your city or zip code. Then click the Search button. This will show a list of pharmacies in the Gainwell network in that zip code area.

Learn More

Get in Touch: For more information, contact Gainwell Technologies at 833-491-0344.