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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)

TThe 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) and the single Pharmacy Benefit Manager (PBM), Gainwell Technologies, has created and maintains a unified preferred drug list.  All Ohio Medicaid MCPs follow the PDL which means the same medications are preferred and the same prior authorization criteria is used This unified list can be found on Gainwell’s website. The PDL identifies preferred medications, non-preferred medications, which medications require prior authorization, and any other limits that may apply to certain medications. 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 refer to the PDL document on Gainwell’s website.

Providers can contact Gainwell with questions about the PDL or the prior authorization process at 833-491-0344.

Resources

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

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

Archived Files