On July 24, the Ohio Department of Medicaid (ODM) released its Request for Proposals (RFP) for the Single Pharmacy Benefit Manager (SPBM). As part of the current budget bill, the Ohio General Assembly directed ODM to select and contract with a SPBM. The RFP and additional details about the SPBM procurement process can be found on the Request for Proposal page of ODM’s website.
Goals of Ohio’s SPBM
Currently, each of Ohio Medicaid’s managed care organizations (MCOs) contracts with a separate PBM for their members. The goal of the SPBM is to develop and implement a single system to improve management and administration of pharmacy benefits for Ohio Medicaid managed care recipients while decreasing costs to the state. By contracting with a single PBM for the entire managed care program, ODM and the State will be equipped with the right tools, resources, and partners to achieve these goals.
Features of Ohio’s SPBM
For Medicaid managed care members, the SPBM will provide more choice in selecting their pharmacy due to fewer out-of-network restrictions. In addition, members will no longer need to consider pharmacy benefits as a decision-making factor when selecting a managed care plan. The SPBM can also incentivize member-valued services and benefits like home delivery, 90 day refills, and adherence programs.
For additional details about the future Ohio Medicaid managed care program and the SPBM procurement, visit the SPBM page the ODM website.