Ohio's Medicaid Prescription Program Changing

Prescriptions for Medicaid Clients enrolled in Managed Care are changing on February 1, 2010

On February 1, 2010, Ohio Medicaid will change the way it provides prescription drugs and some medical supplies to some clients. Ohio will "carve out" these services from the managed care providers and, instead, provide these services through its fee-for-service system.  The carve-out will affect roughly 1.5 million people enrolled in Medicaid managed care.

This change may cause some Medicaid clients more difficulties in accessing their prescriptions or medical supplies. The following is a list of some of the problems we anticipate seeing as Ohio implements these changes.

(1) Finding a pharmacy that accepts Medicaid
Currently, many recipients in managed care obtain their prescriptions through pharmacies that do not accept Ohio Medicaid. Under the carve-out, many people will have to find a pharmacy that accepts Ohio Medicaid.  This may be difficult for some people that live in rural areas and will be more difficult for people when they are out-of-state.

(2) Paying Co-payments
Currently, most adults in managed care do not have co-payments for prescription drugs.  Under the carve-out adults may have co-payments of $2 or $3 for prescription drugs.  For those people with many prescriptions to fill each month, these co-payments can quickly add up.

(3) Adding Newborns to Cases
Currently, newborns have immediate access prescription coverage through their mothers' managed care plan.  But, under the carve-out they may not have access until their county caseworker add them to their mothers' Medicaid case, which may take weeks or months.  In the meantime, parents may have difficulty getting prescriptions filled for their child.
 
(4) Pre-Approved Prescriptions
Currently, many patients are receiving prescription drugs that their managed care plans have previously authorized. But under the carve-out, their doctors will have to obtain prior authorization through the state system.

If you are an Ohio Medicaid client and you need assistance getting your medication or you experience any problems with the new prescription program (either the problems listed above, or others), please contact Chris Barley at cbarley@ohiopovertylaw.org.

When you contact Chris, please include: