On Oct. 1, 2022, the Ohio Department of Medicaid (ODM) moved to a single pharmacy benefit manager, Gainwell Technologies, for all managed care organizations.
How this affects members
Gainwell now manages the pharmacy benefits for UnitedHealthcare Community Plan members in Ohio. As part of the transition from OptumRx to Gainwell, member copayments didn’t change.
Members who have prescription medications that we no longer cover, or have medications with new utilization management criteria, will need their prescribing health care professional to request new prior authorization from Gainwell by:
Visiting their website and signing into their secure portal
Calling their member services at 833-491-0344
What you need to know
We transferred all claim history and current prior authorizations to Gainwell before Oct. 1, 2022
To access the Provider Network Management (PNM) portal, please register for an Ohio Identification (OHID) at the Gainwell website
The new Gainwell codes are as follows:
Bank identification number (BIN): 024251
Processor control number (PCN): OHRXPROD
You can verify coverage and eligibility information by:
Calling Gainwell at 833-491-0344
Visiting the Gainwell website and signing into their secure portal