Privacy Policy Contact OAR Sign In

News & Advocacy

Auditor Report on Ohio’s Medicaid Managed Care Pharmacy Services

posted: August 16, 2018

The Ohio Department of Medicaid (Department) requires Managed Care Plans (Plans) to offer prescription drug benefits. However, these Plans contract third party service organizations, known as Pharmacy Benefit Managers (PBMs), to manage prescription drug benefits on their behalf. PBMs offer a variety of services, including but not limited to: claim adjudications; customer service or call centers; clinical services such as prior authorizations; drug utilization reviews; and mail-order and specialty pharmacies. While Plans outsource these services to PBMs, the Plans remain responsible for the compliance and accuracy of the services a PBM performs pursuant to the Plans’ agreements with the Department.

Read More