Single Pharmacy Benefit Manager (SPBM) and Pharmacy Pricing and Audit Consultant (PPAC)
On October 1, the SPBM began providing pharmacy services across all Medicaid managed care plans and members. Please note the following processes now in place:
- For pharmacy services provided through September 30, authorization and payment is the responsibility of the member’s managed care organization.
- If the member is only enrolled in OhioRISE, continue to submit pharmacy claims and prior authorizations to the fee-for-service (FFS) pharmacy benefits administrator, Change Healthcare.
- Pharmacy claims and prior authorizations for members enrolled in Medicaid FFS should continue to be submitted to the FFS Pharmacy Benefits Administrator, Change Healthcare.
SPBM Web Portal
The public-facing SPBM web portal provides instant access to reference material such as the Unified Preferred Drug List and criteria, the Preferred Diabetic Supply List, the Specialty Drug List, and Quantity Limits List to assist with prescribing medications to Ohio Medicaid managed care members.
The secure SPBM web portal requires the user to enter their credentials. This provides a way to check eligibility of Ohio Medicaid managed care members. It also enables prescribers to submit prior authorizations and view claim and prior authorization history. The portal also features a secure web chat to quickly speak with the SPBM help desk.