Prescription Drugs and Medications


Single Pharmacy Benefit Manager (SPBM)

Beginning October 1, 2022, a Single Pharmacy Benefit Manager (SPBM) will begin providing pharmacy services across all Ohio Medicaid managed care plans and members. Gainwell is the current SPBM.

Gainwell will be responsible for prescription drug prior authorizations, claims, and processing. Learn more about the SPBM and access the secure provider portal at You can also find user guides and resources like the Pharmacy Reference Guide.


BIN and PCN Numbers

BIN: 024251


Unified Preferred Drug List

Gainwell uses the Ohio Department of Medicaid’s (ODM) Unified Preferred Drug List (UPDL). The UPDL is a list of prescription drugs that are recommended for doctors to use. The UPDL is also called a Formulary.

All Medicaid managed care plans and Fee-for-Service (FFS) use the same Unified Preferred Drug List to help prescribers and members know which drugs are covered with or without prior approval.

Using one drug list across all managed care plans and Fee-for-Service helps prescribers and members know which drugs are covered with or without prior approval.

View the current Unified Preferred Drug List (UPDL).

View the Unified Preferred Drug List (UPDL) Updates for the Current Quarter (30-Day Change Notice).

For an archive of UPDL changes, visit the Ohio Department of Medicaid Pharmacy website.


Prior Authorizations

Some drugs require prior authorization (PA). Providers must submit a prior authorization request to Gainwell, the SPBM, and explain why a specific medication and/or a certain amount of a medication is needed. The request must be approved before members can get the medication. Prior authorization may be required if:

  • There is a pharmacy alternative drug available
  • The drug can be misused/abused
  • There are other drugs that must be tried first


Also, some drugs may also have quantity (amount) limits and some drugs are never covered, such as drugs for weight loss.

You can submit a prior authorization request to Gainwell via phone, fax, provider portal, or mail:


Generic Prescription Drug Policy

If a brand name drug is ordered for a Molina Healthcare Medicaid Member and there is a preferred generic drug available, Gainwell will cover the generic drug on the UPDL. If the member must have the brand name drug instead of the generic drug, the prescribing provider must submit a prior authorization request to Gainwell, the SPBM, explaining why the preferred medicine will not work for the member. Gainwell reviews prior authorizations on an individual basis.


Coordinated Services Program (CSP)

The State of Ohio permits MCPs to develop and implement programs to assist certain members that have received drugs that are not medically necessary to establish and maintain a relationship with one provider and/or pharmacy to coordinate treatment. Members selected for Molina Healthcare’s program will be provided additional information and notified of their state hearing rights, as applicable. 



Gainwell, the Single Pharmacy Benefit Manager (SPBM)

Claims Department


Prior Authorizations

  • Phone: (833) 491-0344, Monday – Friday, 8 a.m. – 8 p.m., ET
  • Fax: (833) 679-5491
  • Web portal:
  • Mail: PO Box 3908, Dublin, OH 43016-0472

Molina Healthcare Provider Services Department

Phone: (855) 322-4079, Monday – Friday, 8 a.m. – 5 p.m., ET


pdf Adobe Acrobat Reader is required to view the file(s) above. Download a free version.