Success in Ohio – Medicaid Managed Care Rx Dispensing Fees Increasing
Working with the Ohio Pharmacists Association (OPA) and other Ohio pharmacy groups, IPC had success in the final Ohio 2024-2025 state budget of gaining a 5.7% increase in the Ohio Medicaid managed care single PBM professional dispensing fee, processed by GainWell Technology.
Starting with managed care prescription claims filled on or after July 1, the new 3-tiered dispensing fees are as follows:
| Tiers | Tier Threshold (Annual Scripts) | New MMC Rx PDF |
|---|---|---|
| Tier 1 | 75K+ scripts | $7.64 x 5.7% = $8.07 |
| Tier 2 | 50K – 74.999K scripts | $8.75 x 5.7% = $9.24 |
| Tier 3 | Fewer than 50K scripts | $10.50 x 5.7% = $11.09 |
This increase will bring the Ohio Medicaid managed care prescription reimbursement into near parity with the Ohio Medicaid fee-for-service dispensing fee rates. Please thank Governor Michael DeWine and your state legislators for upholding their commitment with the new Medicaid managed care Single PBM Contract to ensure pharmacy payments would be a cost-based, transparent system.
The adopted state budget also provides additional funding opportunities to pharmacies for Medicaid value-based payment. Details on how this program will work are to be determined in the coming weeks. More updates to follow.
Questions?
Please contact IPC’s Government Relations Department at [email protected]
