As a Humana Healthy Horizons® in Ohio member, your pharmacy services are covered by Gainwell, Ohio Medicaid’s Single Pharmacy Benefit Manager (SPBM).
Your prescription coverage
Gainwell covers all Medicaid-covered, medically necessary prescription and over-the-counter (OTC) medications. As a Humana Healthy Horizons in Ohio member, you must use network providers, facilities, and pharmacies to get covered services, including medications. This coverage includes medicine available through the Ohio Department of Medicaid (ODM) Unified Preferred Drug List (PDL).
Gainwell also offers coverage for over-the-counter items.
Preferred drug list
The ODM Unified PDL is a list of medicine Ohio Medicaid recipients can use if prescribed. A Pharmacy and Therapeutics (P&T) Committee recommends medicine to include on or remove from the PDL. Medicine on the PDL is identified as preferred or nonpreferred and includes information about prior authorization requirements.
If your provider wants you to take medicine that requires prior authorization, he or she will submit a prior authorization request to Gainwell.