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Ohio officials expect that consolidating the seven private pharmacy benefit managers that run its Medicaid managed-care system into a single, state-regulated PBM will save more than $240 million every year. The change will go in effect starting in early 2022.
Officials will administer PBM services through Gainwell Technologies, a state-regulated PBM that will replace the seven PBMs currently operating in the managed-care system. A pharmacy pricing and audit consultant will help state officials make decisions with regard to in-network providers, pharmacy reimbursement and more.
Ohio Department of Medicaid Director Maureen Corcoran declined to name the consultant working with Ohio.
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New Ohio Department of Medicaid rule expands pharmacists reimbursement options
Discount Drug Mart pharmacist Larissa Venditti spends time with a customer.
Though pharmacists are among the most accessible health care professionals, many patients may be hard pressed to name the medication expert who fills their prescriptions. If you ask a patient to name their dentist, name their physician and name their pharmacist, it s harder for them unless they go to an independent pharmacy to name their pharmacist, said Ernest Boyd, executive director of the Ohio Pharmacists Association.
A new rule from the Ohio Department of Medicaid may provide opportunities for them to strengthen their relationships with patients by allowing reimbursement for pharmacists performing certain clinical activities.
Opinion: OhioRISE will help youth with behavioral health challenges
Angela Sausser
When children need emergency surgery or face a chronic physical condition, they can usually get the medical treatment they need through their family’s private or Medicaid insurance, or the Children’s Health Insurance Program. But when young people sink into a deep depression, act out violently or harm themselves, treatment options are limited.
A new specialized managed care program called OhioRISE Resilience through Integrated Systems and Excellence could improve Ohio’s approach to serving youth with complex behavioral health needs. The Ohio Department of Medicaid is prioritizing treatment services for children with complex needs, including those in foster care.
Ohio has $50M plan to shrink nursing home bed count Kaitlin Schroeder
Older Ohioans overwhelmingly prefer to stay home and out of a nursing home as long as possible, and when in a nursing home, people primarily want the room to themselves.
This has prompted the DeWine administration to propose a $50 million fund that would buy back bed licenses from nursing homes and shrink the number of beds in the region. The fund is proposed as part of DeWine’s newly unveiled two-year operations budget proposal, which will be considered by the Ohio General Assembly.
Even though the number of older adults in Ohio has grown, occupancy rates have fallen in nursing homes. People instead stay home with the help of health aides or seek alternatives as they get older like assisted living choices boosted over the years by funding programs for eligible people.