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Pharmacy

Buckeye Health Plan is committed to providing appropriate, high-quality, and cost-effective drug therapy to all Buckeye Health Plan members. Buckeye Health Plan covers prescription medications and certain over-the-counter medications with a written order from a Buckeye Health Plan provider. The pharmacy program does not cover all medications. Some medications may require prior authorization and some may have limitations. Other medically necessary pharmacy services are covered as well.

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), is moving toward creating a unified preferred drug list (PDL). Beginning January 1, 2020, 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 (The Preferred Drug List (PDL) Effective 01.01.20) (PDF) of drugs will help you know which drugs are covered with or without prior approval. Prior approval is also called prior authorization.

Thank you in advance for your cooperation. Providers may refer to the ODM Pharmacy website https://pharmacy.medicaid.ohio.gov/ under “Drug Coverage” for more information. Please note that the ODM website is to only be used as a reference and we encourage our providers to use The Preferred Drug List (PDL) Effective 01.01.20 (PDF) for the changes effective 01.01.2020.

Throughout the course of 2020, prescribers may need to transition certain patients from their current medication(s) or complete a prior authorization for the patient to stay on his/her current medication(s). As a reminder, here is our Prior Authorization Fax Number: Prior Authorization Fax Number: 877-386-4695.

Resources

Use our Medicaid Preferred Drug List (PDF) to find more information on the drugs that are covered and drugs that require prior authorization. 

PDL Updates

Buckeye Health Plan routinely reviews medications available on the Preferred Drug List. Items are added, removed or modified periodically due to industry standard, market availability, and/or assessment of use. The document below outlines changes to the published PDL for the current quarter.

Buckeye Health Plan (BHP) routinely reviews their Prior Authorization (PA) and Medical Necessity (MN) criteria. Decisions on PA and MN criteria content are coordinated with input from pharmacy and medical practitioners, Buckeye Health Plan representatives, and review of current available medical literature and professional standards of practice. Below is the list of changes to the Medicaid criteria this quarter.

Resources

For additional pharmacy information and resources regarding Buckeye's Medicare Advantage plan, please see the Prescription Drug & Forumulary pages on our Allwell website

Resources

For additional pharmacy information and resources regarding Buckeye's Medicaid-Medicare Plan (MMP), please see the Prescription Drug & Formulary pages on our MyCare Ohio website. 

For pharmacy information and resources regarding Buckeye's Health Insurance Marketplace plan, please see the Pharmacy page on our Ambetter website