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Pharmacy

Humana Healthy Horizons® in Ohio members get prescription drug coverage through Gainwell, Ohio Medicaid’s Single Pharmacy Benefit Manager (SPBM). Gainwell covers all Medicaid-covered, medically necessary prescription and over-the-counter (OTC) medications. Our members must use only Gainwell network pharmacies to get medications under the pharmacy benefit.

Pharmacist fills a prescription

Drug coverage

At the Gainwell 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 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.

Training opportunities

On October 1, 2022, Gainwell Technologies, the Single Pharmacy Benefit Manager (SPBM), will begin providing pharmacy services across all managed care plans and for all members.

In preparation for the launch of the SPBM, ODM is offering a variety of trainings. These trainings are a great opportunity for providers to gain knowledge that will benefit our members.

SPBM trainings

ODM will offer several SPBM training opportunities starting Sept. 6. Training is offered via online instructor-led webinars, recorded online training, and weekly Q&A forums.

Trainings will cover several topics, including:

  • SPBM login and access
  • System navigation
  • Verifying member pharmacy benefit eligibility
  • Submitting and viewing pharmacy claims
  • Submitting and viewing pharmacy prior authorizations

Register for one or more of the ODM training sessions