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Humana Healthy Horizons™ in Ohio provides coverage of medically necessary medications, prescribed by Medicaid certified licensed prescribers in the state. Humana adheres to state and federal regulations on medication coverage for our members.

Pharmacist fills a prescription

Drug coverage

Humana and other health plans in the state are required to use a single pharmacy benefit manager (SPBM), Gainwell Technologies. Gainwell Technologies provides pharmacy benefits for all Ohio Medicaid individuals.

At the Gainwell Technologies website, you can find key information from Gainwell, or directions for accessing key information, including:

  • Provider Network Management Module
  • Contact information
  • Searchable Preferred Drug List
  • Drug coverage information
  • Provider communications
  • Prior authorization procedures and forms
  • Answers to frequently asked questions

Gainwell Technologies utilizes a uniform Preferred Drug List (PDL) and utilization management that the Ohio Department of Medicaid (ODM) develops. The PDL includes some preferred brands, as well as preferred diabetic supplies, such as blood glucose test strips, lancets, meters, and syringes. ODM will notify providers of changes to the PDL.

Medications on the PDL will have a $0 copayment when filled at a network pharmacy.

ODM Unified PDL

Medication Therapy Management

Humana offers a Medication Therapy Management (MTM) program that helps ensure patients achieve the best possible outcomes from their medications. The patient-centered MTM program promotes collaboration among the pharmacist, patient, and prescriber to optimize safe and effective medication use. The goal of this program is to optimize therapeutic outcomes by focusing on safety, effectiveness, lower-cost alternatives, and adherence.

Prescribers with questions about the program may call 888-210-8622 (TTY: 711), Monday – Friday, 8 a.m. – 7 p.m., Eastern time.

Over-the-counter health and wellness

Humana Healthy Horizons in Ohio members have an expanded pharmacy benefit, which provides a $30 per month allowance to spend on over-the-counter (OTC) health and wellness items. UPS or the U.S. Postal Service will send these OTC products in 10–14 working days after the order is received. There is no charge to the member for shipping. See the OTC Order Form and catalog, PDF of available health and wellness items.

If you have questions about this mail-order service, call Humana Pharmacy® at 855-211-8370 (TTY: 711).