5111.172 Requiring coverage of prescription drugs for medicaid recipients. - Ohio Statutes

5111.172 Requiring coverage of prescription drugs for medicaid recipients.

(A) When contracting under section 5111.17 of the Revised Code with a managed care organization that is a health insuring corporation, the department of job and family services may require the health insuring corporation to provide coverage of prescription drugs for medicaid recipients enrolled in the health insuring corporation. In providing the required coverage, the health insuring corporation may, subject to the department’s approval, use strategies for the management of drug utilization.

(B) As used in this division, “controlled substance” has the same meaning as in section 3719.01 of the Revised Code.

If a health insuring corporation is required under this section to provide coverage of prescription drugs, the department shall permit the health insuring corporation to develop and implement a pharmacy utilization management program under which prior authorization through the program is established as a condition of obtaining a controlled substance pursuant to a prescription. The program may include processes for requiring medicaid recipients at high risk for fraud or abuse involving controlled substances to have their prescriptions for controlled substances filled by a pharmacy, medical provider, or health care facility designated by the program.

Effective Date: 06-26-2003; 2007 HB119 09-29-2007