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, Preferred Drug List Effective 04.01.2023 (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 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 Preferred Drug List Effective 04.01.2023 (PDF).
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
- Preferred Diabetes Supplies Covered Thru the Pharmacy Benefit (PDF)
- Medication Safety & Disposal Brochure (PDF)
- CVS MAC Appeals Process (PDF)
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.
- Preferred Drug List 1st Quarter, 2015 Updates (PDF)
- Preferred Drug List 2nd Quarter, 2015 Updates (PDF)
- Preferred Drug List 3rd Quarter, 2015 Updates (PDF)
- Preferred Drug List 4th Quarter, 2015 Updates (PDF)
- Preferred Drug List 1st Quarter, 2016 Updates (PDF)
- Preferred Drug List 2nd Quarter, 2016 Updates (PDF)
- Preferred Drug List 3rd Quarter, 2016 Updates (PDF)
- Preferred Drug List 4th Quarter, 2016 Updates (PDF)
- Preferred Drug List 1st Quarter, 2017 Updates (PDF)
- Preferred Drug List 2nd Quarter, 2017 Updates (PDF)
- Preferred Drug List 3rd Quarter, 2017 Updates (PDF)
- Preferred Drug List 4th Quarter, 2017 Updates (PDF)
- Preferred Drug List 4th Quarter, 2017 Updates (12/18/2017) (PDF)
- Preferred Drug Lilst 1st Quarter, 2018 Updates (PDF)
- Preferred Drug List 2nd Quarter, 2018 Updates (PDF)
- Preferred Drug List 3rd Quarter, 2018 Updates (PDF)
- Preferred Drug List 3rd Quarter, 2018 Updates (September 2018) (PDF)
- Preferred Drug List 2nd Quarter, 2019 Updates (PDF)
- Preferred Drug List 1st Quarter, 2020 Updates (PDF)
- Preferred Drug List 3rd Quarter, 2020 Updates (PDF)
- Preferred Drug List 4th Quarter, 2020 Updates (PDF)
- Preferred Drug List 1st Quarter, 2021 Updates (PDF)
- Preferred Drug List 2nd Quarter, 2021 Updates (PDF)
- ODM Q2 2021 PDL Changes Eff 07-01-2021 (PDF)
- 20220101 30-day Change Notice Final (PDF)
- PDL Non-Preferred Updates effective 4-1-22 (PDF)
- 20220222 30 Day Change Notifications (PDF)
- 20221001 30 Day Change Notifications (PDF)
- 20230101 30 Day Change Notifications (PDF)
- 20230401 30 Day Change Notifications (PDF)
- 20230701 30 Day Change Notification (PDF)
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.
- Medicaid Guideline Summary Table: Medicaid Criteria 1st Quarter, 2017 Updates (PDF)
- Medicaid Guideline Summary Table: Medicaid Criteria 2nd Quarter, 2017 Updates (PDF)
- Medicaid Guideline Summary Table: Medicaid Criteria 3rd Quarter, 2017 Updates (PDF)
- Medicaid Guideline Summary Table: Medicaid Criteria 4th Quarter, 2017 Updates (PDF)
- Medicaid Guideline Summary Table: Medicaid Criteria 1st Quarter, 2018 Updates (PDF)
- Medicaid Guideline Summary Table: Medicaid Criteria 2nd Quarter, 2018 Updates (PDF)
- Medicaid Guideline Summary Table: Medicaid Criteria 3rd Quarter, 2018 Updates (PDF)
- Medicaid Guideline Summary Table: Medicaid Criteria 4th Quarter, 2018 Updates (PDF)
- Medicaid Guideline Summary Table: Medicaid Criteria 1st Quarter, 2019 Updates (PDF)
- Medicaid Guideline Summary Table: Medicaid Criteria 2nd Quarter, 2019 Updates (PDF)
- Medicaid Guideline Summary Table: Medicaid Criteria 3rd Quarter, 2019 Updates (PDF)
- Medicaid Guideline Summary Table: Medicaid Criteria 4th Quarter, 2019 Updates (PDF)
- Medicaid Guideline Summary Table: Medicaid Criteria 1st Quarter, 2020 Updates (PDF)
- Medicaid Guideline Summary Table: Medicaid Criteria 2nd Quarter, 2020 Updates (PDF)
- Medicaid Guideline Summary Table: Medicaid Criteria 3rd Quarter, 2020 Updates (PDF)
- Medicaid Guideline Summary Table: Medicaid Criteria 4th Quarter, 2020 Updates (PDF)
- Medicaid Guideline Summary Table: Medicaid Criteria 1st Quarter, 2021 Updates (PDF)
- 21Q2 Combined Guidelines Summary (PDF)
- Medicaid Guidelines Summary 21Q3 (PDF)
- Medicaid Guidelines Summary 21Q4 (PDF)
- Medicaid Guidelines Summary 22Q2 (PDF)
- Medicaid Guidelines Summary Q3 22 (PDF)
- Medicaid Guidelines Summary Q4 22 (PDF)
- Medicaid Guidelines Summary Q1 23 (PDF)
- Medicaid Guidelines Summary Q2 23 (PDF)
Resources
High Risk Medications in the Elderly (PDF)
For additional pharmacy information and resources regarding Buckeye's Medicare Advantage plan, please see the Prescription Drug & Forumulary pages on our Allwell website.
Resources
High Risk Medications in the Elderly (PDF)
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.