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Medicaid Program Changes, SB 154: Pharmacy Relationships

Important Changes in Medicaid Program

Beginning February 1, 2010, prescription drug coverage for members of Medicaid managed care plans (MCPs) transferred to the Medicaid fee-for-service (FFS) program. This change means that all Medicaid consumers now have the same list of covered drugs and same prior authorization policy. Medicaid MCPs are no longer responsible for prescription drug coverage for their members. Important changes for Ohio pharmacies include: 1. All Medicaid reimbursement will be reduced to $1.80. 2. Medicaid prescriptions may be subject to the following co-payments: $3 on all non-formulary drugs $2 on brand name drugs Pharmacists have the right to refuse service to patients who refuse to pay the co-pay after the first time, if this is the normal course of business with cash paying customers and third party payers. 3. Federal requirements for tamper-resistant prescription pads will now include all prescriptions. Prescriptions transmitted to the pharmacy via telephone, fax, or e-prescribing, in accordance with Ohio Board of Pharmacy regulations, are exempt from this requirement. To be considered tamper resistant, a prescription form must contain all of the following three characteristics:
•one or more features designed to prevent unauthorized copying of a completed or blank prescription forms;
•one or more features designed to prevent the erasure or modification of information written on the prescription by the prescriber;
•one or more features designed to prevent the use of counterfeit prescription forms.


SB 154: Pharmacy Relationships

Subject.  To prohibit PBMs that have a relationship with a retail pharmacy from using that relationship to the competitive disadvantage of other retail pharmacies. Primary Sponsor. Senator Patton OPA members Mimi Hart, R.Ph. and Tom Whiston, R.Ph. offered testimony on the damaging effect of many PBM data-sharing policies at a Senate Insurance Committee hearing February 23. More information on this topic is available at the following link:
Pharmacy Relationships

If you have any questions or comments about the issues mentioned in this article, please contact Kelly Vyzral, Director of Government Affairs, at 614.586.1497 or kvyzral@ohiopharmacists.org.


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