December 01, 2022
New Ohio Community Plan pharmacy benefit manager
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
- You can use the Ohio Unified Preferred Drug List
- To find an in-network pharmacy, please:
- Call Gainwell provider services 24/7 at 833-491-0344
- Use the Gainwell Pharmacy Search
More information
- Visit ODM’s October 1 Launch of the Next Generation of Ohio Medicaid Program guide to access information about the changes, the new member ID cards and the contact information for Gainwell
