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Ohio Medicaid taking greater control of prescription drug coverage

Making good on a promise to keep a closer watch on pharmacy middlemen and drug prices in Ohio’s $28 billion health-care program for the poor and disabled, state Medicaid officials unveiled a single list of medications Friday it will cover without prior authorization for all beneficiaries.

The Unified Prescription Drug List, to be implemented Jan. 1, will replace multiple formularies now established by pharmacy benefit managers, or PBMs, hired by the five managed care plans to oversee drug benefits. Medicaid officials also plan to eventually move to a single PBM to streamline services.

“Our focus is on ensuring Medicaid members can safely access their prescriptions without potential delays, while reducing confusion for providers,” said Medicaid Director Maureen Corcoran. “Maintaining a single, consistent list of medications also increases transparency, which aligns with our strategy and approach to the pharmacy benefit in Medicaid.”

Medicaid provides health coverage to nearly 3 million Ohioans and spends about $3 billion a year on prescription drugs.

With a single drug list, all Ohio managed care plans will cover the same drugs and use the same prior authorization criteria. If beneficiaries change plans, they no longer would face the possibility of having to change medications if their new plan doesn’t cover the same drug.

Medicaid recipients now using a medication covered by their current plan but not included on the new drug list will continue to have those prescriptions covered, officials said.

Members who receive both Medicaid and Medicare benefits, the MyCare Ohio program, will not be affected by this change.