(From the January 2023 Issue of MedStat) Gainwell and Its Impact on Homecare Gainwell is now the single pharmacy benefit manager for all Ohio Medicaid managed care plans, a part of the Next Generation of Ohio Medicaid Managed Care . This change became effective in October 2022. The consolidation is meant to simplify the process and create one entity through which all pharmacy benefit prior authorizations and claims will be processed. Gainwell only handles patients in one of the seven managed care programs. Ohio Medicaid patients not placed in a managed care plan (fee-for-service) will continue to be authorized through Change Healthcare. There have been several challenges, especially as it relates to prior authorizations. The major change that providers should be aware of is that there is a single form that must be filled out and signed by the prescribing physician or a staff member of the physician. The form is required for every prior authorization submitted and is the only way the Homecare team can move forward with the order and receive a decision prior to the drug being dispensed to the patient. Visit the Gainwell website to determine what drugs are covered. Under the Reference Material tab, there is a Drug Search feature to research which drugs are preferred. Even if the patient’s drug is not listed, it may still be covered if additional documentation is provided for the prior authorization (PA) and may even entail peer-to-peer review for PA approval. These coverages may have changed from the previous plan. Unfortunately, patients receiving a drug previously through the managed care medical benefit may no longer be covered for the same drug under the Gainwell pharmacy benefit unless there is a new PA. Homecare has continued to grow services to answer patient needs. Homecare’s HME facility has increased in size and capabilities. Take a video tour of the HME facility. The new HME fact sheet will be available in February.
If you have questions regarding this article, or any of Homecare’s services email Carolyn Figi or click here to view services online or access Homecare’s ANCHOR page.
(From the January 2023 Issue of MedStat) Gainwell and Its Impact on Homecare Gainwell is now the single pharmacy benefit manager for all Ohio Medicaid managed care plans, a part of the Next Generation of Ohio Medicaid Managed Care . This change became effective in October 2022. The consolidation is meant to simplify the process and create one entity through which all pharmacy benefit prior authorizations and claims will be processed. Gainwell only handles patients in one of the seven managed care programs. Ohio Medicaid patients not placed in a managed care plan (fee-for-service) will continue to be authorized through Change Healthcare. There have been several challenges, especially as it relates to prior authorizations. The major change that providers should be aware of is that there is a single form that must be filled out and signed by the prescribing physician or a staff member of the physician. The form is required for every prior authorization submitted and is the only way the Homecare team can move forward with the order and receive a decision prior to the drug being dispensed to the patient. Visit the Gainwell website to determine what drugs are covered. Under the Reference Material tab, there is a Drug Search feature to research which drugs are preferred. Even if the patient’s drug is not listed, it may still be covered if additional documentation is provided for the prior authorization (PA) and may even entail peer-to-peer review for PA approval. These coverages may have changed from the previous plan. Unfortunately, patients receiving a drug previously through the managed care medical benefit may no longer be covered for the same drug under the Gainwell pharmacy benefit unless there is a new PA. Homecare has continued to grow services to answer patient needs. Homecare’s HME facility has increased in size and capabilities. Take a video tour of the HME facility. The new HME fact sheet will be available in February.
If you have questions regarding this article, or any of Homecare’s services email Carolyn Figi or click here to view services online or access Homecare’s ANCHOR page.
(From the January 2023 Issue of MedStat) Gainwell and Its Impact on Homecare Gainwell is now the single pharmacy benefit manager for all Ohio Medicaid managed care plans, a part of the Next Generation of Ohio Medicaid Managed Care . This change became effective in October 2022. The consolidation is meant to simplify the process and create one entity through which all pharmacy benefit prior authorizations and claims will be processed. Gainwell only handles patients in one of the seven managed care programs. Ohio Medicaid patients not placed in a managed care plan (fee-for-service) will continue to be authorized through Change Healthcare. There have been several challenges, especially as it relates to prior authorizations. The major change that providers should be aware of is that there is a single form that must be filled out and signed by the prescribing physician or a staff member of the physician. The form is required for every prior authorization submitted and is the only way the Homecare team can move forward with the order and receive a decision prior to the drug being dispensed to the patient. Visit the Gainwell website to determine what drugs are covered. Under the Reference Material tab, there is a Drug Search feature to research which drugs are preferred. Even if the patient’s drug is not listed, it may still be covered if additional documentation is provided for the prior authorization (PA) and may even entail peer-to-peer review for PA approval. These coverages may have changed from the previous plan. Unfortunately, patients receiving a drug previously through the managed care medical benefit may no longer be covered for the same drug under the Gainwell pharmacy benefit unless there is a new PA. Homecare has continued to grow services to answer patient needs. Homecare’s HME facility has increased in size and capabilities. Take a video tour of the HME facility. The new HME fact sheet will be available in February.
If you have questions regarding this article, or any of Homecare’s services email Carolyn Figi or click here to view services online or access Homecare’s ANCHOR page.
(From the January 2023 Issue of MedStat)
Gainwell and Its Impact on Homecare
Gainwell is now the single pharmacy benefit manager for all Ohio Medicaid managed care plans, a part of the Next Generation of Ohio Medicaid Managed Care . This change became effective in October 2022. The consolidation is meant to simplify the process and create one entity through which all pharmacy benefit prior authorizations and claims will be processed. Gainwell only handles patients in one of the seven managed care programs. Ohio Medicaid patients not placed in a managed care plan (fee-for-service) will continue to be authorized through Change Healthcare.
There have been several challenges, especially as it relates to prior authorizations. The major change that providers should be aware of is that there is a single form that must be filled out and signed by the prescribing physician or a staff member of the physician. The form is required for every prior authorization submitted and is the only way the Homecare team can move forward with the order and receive a decision prior to the drug being dispensed to the patient.
Visit the Gainwell website to determine what drugs are covered. Under the Reference Material tab, there is a Drug Search feature to research which drugs are preferred. Even if the patient’s drug is not listed, it may still be covered if additional documentation is provided for the prior authorization (PA) and may even entail peer-to-peer review for PA approval. These coverages may have changed from the previous plan. Unfortunately, patients receiving a drug previously through the managed care medical benefit may no longer be covered for the same drug under the Gainwell pharmacy benefit unless there is a new PA.
Homecare has continued to grow services to answer patient needs. Homecare’s HME facility has increased in size and capabilities. Take a video tour of the HME facility. The new HME fact sheet will be available in February.
If you have questions regarding this article, or any of Homecare’s services email Carolyn Figi or click here to view services online or access Homecare’s ANCHOR page.
