As of February 1, 2010, the Ohio Medicaid fee-for-service (FFS) program manages prescription drug and certain medical supply coverage for all Ohio Medicaid members. Private managed care plans, such as WellCare of Ohio, that cover Ohio Medicaid members are transferring responsibility of this coverage.

• This change does impact:
  
   
  • Prescription drugs that are administered in the patient’s home, home health settings or a nursing facility.
  • Some medical supplies, such as diabetic testing supplies, supplies for injection of insulin and other drugs, inhaler spacers and peak flow meters.
  • Retail pharmacy orders.

These prescriptions now need to be billed through the Ohio Medicaid FFS program. (Please note that prescriptions billed through the Ohio Medicaid FFS program may be subject to co-payments.)

• This change does not impact:
  
   
  • Covered drugs administered to members in a physician’s office, hospital outpatient department, clinic, dialysis center or infusion center.
  • These covered drugs will continue to be WellCare’s responsibility and will be subject to existing WellCare coverage, authorization and billing requirements.

Ohio Medicaid FFS Program Authorizations:

To request a prior authorization, or if you have questions or issues pertaining to a prior authorization request, the prescribing provider or a member of his/her staff should contact ACS at:

Phone:	1-877-518-1546 (Monday to Friday; 7 a.m. to 7 p.m. EST)
Fax:	1-800-396-4111

Ohio Medicaid FFS Program Information:

Information about the Ohio Medicaid FFS program, including a “quick list” of preferred drugs, approved drug list, Pharmacy Provider Manual, prior authorization request fax form and more is available on the following Web site: http://jfs.ohio.gov/ohp/bhpp/meddrug.stm

WellCare Authorizations:

Certain injectable drugs administered at the provider’s office require prior authorization. The WellCare Injectable Infusion prior authorization form can be found on this page.

Certain medications in drug classes may require prior authorization. To get authorization, the provider must submit the appropriate prior authorization form to the WellCare Pharmacy department. The fax number is 1-877-277-6892. The WellCare Pharmacy department will respond to all requests within 24 hours, and if authorized, will coordinate delivery of the product.

Prior authorization requests are reviewed for appropriate utilization criteria. Once approved, the member is able to obtain the medication at the physician's office. WellCare Pharmacy Services can be reached by calling 1-800-678-3184, Monday through Friday, 8 a.m. to 9 p.m. EST, with any questions regarding prior authorizations for injectable drugs.

Some drug classes that may require prior authorization include:

• Growth hormones
• Colony Stimulating Factors
• Immunoglobulins
• Androgens
• Estrogens
• Metabolic enzymes
• Hemostatics
• Disease-Modifying Antirheumatic Drugs (DMARDs)

Pharmacy Forms

• Enteral Nutritional Supplement Form
• Injectable-Infusion Prior Authorization Form
• Prior Authorization Request Form