SPBM

Gainwell Portal

Gainwell Call Center
Phone: 833-491-0344 (TTY 1-833-655-2437)
Fax: 833-679-5491

Single Pharmacy Benefit Manager (SPBM) ODM website. 

For questions about the Next Generation program, contact ODMNextGen@medicaid.ohio.gov.

On October 1, 2022, the Single Pharmacy Benefit Manager (SPBM) began providing pharmacy services across all Ohio Medicaid managed care plans and members. The SPBM does not include MyCare Ohio members. Please note the following processes are now in place:

• For pharmacy services provided through September 30, 2022, authorization and payment is the responsibility of the member’s managed care organization (MCO).
• If the member is only enrolled in OhioRISE, continue to submit pharmacy claims and prior authorizations to the fee-for-service (FFS) pharmacy benefits administrator, Change Healthcare.
• Pharmacy claims and prior authorizations for members enrolled in Medicaid FFS should continue to be submitted to the FFS pharmacy benefits administrator, Change Healthcare.

On and after July 1, 2023, pharmacy claims and prior authorizations for members enrolled in Medicaid FFS will be submitted to the SPBM.

Additional Reference Materials

In July, ODM hosted a webinar for providers on the Next Generation's Stage 2 October 1 launch. This webinar included an overview of the new modules and upcoming provider training plans and dates. Please see below for a recording of the session and the corresponding slides.

• Next Generation Ohio Medicaid Program Provider Overview Slides
• Next Generation Ohio Medicaid Program Provider Overview Recording