Your Ohio Medicaid drug coverage
Learn which drugs are covered by your Medicaid plan, where to get them filled, and how to check your drug list.
Molina Healthcare works with a Single Pharmacy Benefit Manager (SPBM) to help you with your prescription drug needs. The SPBM helps all Medicaid plans in Ohio. It makes sure you get good care and can use many pharmacies.
Gainwell is the SPBM that will help you with your medications. Call Gainwell Member Services at (833) 491-0344 (TTY 711), 24 hours a day, 7 days a week, for help.
Gainwell uses the Ohio Department of Medicaid's (ODM) Unified Preferred Drug List (UPDL). The UPDL is a list of drugs that doctors should use first. It is also called a drug list or formulary.
The drug list explains rules like how much medicine you can get, age limits, and other details that may affect what is covered.
All Medicaid managed care plans and Medicaid Fee-for-Service in Ohio use the same drug list. This helps make sure everyone has the same drug coverage.
To see if your drug is covered, use the drug look up tool or view your state’s drug list
You can also view recent changes to the Unified Preferred Drug List (30-day change notice).
What’s Covered
You have no co-pays or out-of-pocket costs for covered prescription medications.
If you have an emergency and need drugs, Gainwell will provide up to a 72-hour supply of the drug.
If your provider orders a drug that is not covered under the UPDL, your doctor can submit a request for prior authorization to Gainwell for you. Your doctor knows how to submit information for your authorization request. You can view this information at spbm.medicaid.ohio.gov.
Drugs included on the Specialty Drug List must be filled at a Gainwell Ohio SPBM pharmacy.
Call Gainwell Member Services at (833) 491-0344 (TTY 711), 24 hours a day, 7 days a week if you have questions on getting your specialty medication filled.