Ohio Medicaid Launches Next Phase Of Managed Care Transformation: Single Pharmacy Benefit Manager & Simplified Provider Credentialing

The Ohio Department of Medicaid (ODM) launched the single pharmacy benefit manager (SPBM) and new provider enrollment process and centralized credentialing through the Provider Network Management system. These new approaches, which went live on October 1, 2022, are part of the state’s Next Generation managed care implementation. The SPBM is intended to improve transparency for Medicaid pharmacy services. The new credentialing process is intended to ease administrative burden on provider organizations.

The SPBM, operated by Gainwell Technologies, addresses years of concerns raised by pharmacies and stakeholders regarding obscure reimbursement methodologies and conflicts of interest that allegedly diverted profits to . . .