2011 Ohio Revised Code
Title [51] LI PUBLIC WELFARE
Chapter 5111: MEDICAL ASSISTANCE PROGRAMS
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 shall 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 and the limitations specified in division (B) of this section, use strategies for the management of drug utilization.
(B) The department shall not permit a health insuring corporation to impose a prior authorization requirement in the case of a drug to which all of the following apply:
(1) The drug is an antidepressant or antipsychotic.
(2) The drug is administered or dispensed in a standard tablet or capsule form, except that in the case of an antipsychotic, the drug also may be administered or dispensed in a long-acting injectable form.
(3) The drug is prescribed by either of the following:
(a) A physician whom the health insuring corporation, pursuant to division (C) of section 5111.17 of the Revised Code, has credentialed to provide care as a psychiatrist;
(b) A psychiatrist practicing at a community mental health agency certified by the department of mental health under section 5119.611 of the Revised Code.
(4) The drug is prescribed for a use that is indicated on the drug’s labeling, as approved by the federal food and drug administration.
(C) As used in this division, “controlled substance” has the same meaning as in section 3719.01 of the Revised Code.
The department shall permit a 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.
Amended by 129th General Assembly File No. 28, HB 153, § 101.01, eff. 9/29/2011.
Amended by 129th General Assembly File No. 19, HB 93, § 1, eff. 5/20/2011.
Effective Date: 06-26-2003; 2007 HB119 09-29-2007
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