Pharmacy Prior Authorizations

Outpatient pharmacy

Pharmacy Benefit Manager (PBM) services are managed by the single pharmacy benefit manager (SPBM), Gainwell Technologies. For the most current and complete information on the provision of pharmacy services, please visit the Gainwell website.

On Gainwell’s website, you can access information about:

  • Drug coverage
  • Unified Preferred Drug List
  • Prior authorization procedures and forms
  • Answers to frequently asked questions

For questions regarding PBM services, Plan providers may contact Gainwell at 1-833-491-0344.

Physician-administered medications

Medications billed via the medical benefit (CMS 1500 or UB-04) are reviewed by our PBM, PerformRxSM. You can submit a prior authorization request online here or download a form here to submit via fax (PDF).

Formulary

Gainwell utilizes the Ohio Medicaid Unified Preferred Drug List (UPDL). The drug benefit has been developed to cover medically necessary prescription products and over-the-counter (OTC) medications. The pharmacy benefit design provides for outpatient prescription services that are appropriate, medically necessary, and are not likely to result in adverse medical outcomes.

The formulary is available on Gainwell’s website. The UPDL is available online on the Gainwell website.

Providers