Ohio Drug Search Help

v.1.0.3 r.7276 b.100 d.2016-06-03 10:06 AM EDT

The Ohio Department of Medicaid (ODM) Drug Look Up Tool helps provide additional information on Medicaid drug coverage. Please Note: This site should be used for REFERENCE ONLY. It is not to be used to verify payment of a particular product by Ohio Medicaid. Co-payment information is given for informational purposes only, as some consumers are exempt from co-payments. Coverage, co-payment and price per unit should be based on the response received from the pharmacy claims processor and not solely on the information on this site. Information provided on this page is regularly updated and should only be viewed as a reference for the date listed on the search results page.

For further questions or comments about this web page please send an e-mail to the following e-mail address:
OHDrugLookUpTool@ghsinc.com

Glossary

Drug Code
This field displays the National Drug Code (NDC) associated with the medication. The NDC is an 11-digit, 3-segment number. The segments can be used to identify the labeler of the medication, the product (within the scope of the labeler) and the package size.
Brand Status
This field displays whether the associated medication is considered a brand or generic medication in the ODM claim adjudication system.
Product Description
An abbreviated description of the medication, which is typically comprised of the product name, dosage form and strength. Dosage form may be abbreviated as follows:
TAB = Tablet
CAP = Capsule
INJ = Injection
SOL = Solution
SUS = Suspension
POW = Powder
SYP = Syrup
SUP = Suppository
Route of Administration
Describes how the medication is to be taken or used (e.g. oral, injection, etc.)
Package
The package size represents the number of dosage units included in one package.
Prior Authorization Required
Prior Authorization Required indicates whether the medication requires prior authorization before it will be paid by ODM. It should be noted that certain medications may have additional limitations in place for coverage (e.g., age, gender, dose, etc.) and may require a prior authorization when the prescribing falls outside of these limits. For those medications where YES is indicated, additional information from a provider may be needed before the medication can be processed.
Covered for Dual Eligible
A dual eligible is an individual who is entitled to Medicare and is eligible for some form of Medicaid benefit. If a medication is covered under the Medicaid program for a consumer who is a dual eligible, the value will be "Yes."
DEA Class
For controlled substances.
Copay
The copay field represents an estimate of the payment that may be required of a beneficiary at the time the medication is dispensed. For more information on these requirements, please refer to OAC § 5160-1-09
Price Per Unit
The price per unit field represents an estimate of the maximum amount of reimbursement a pharmacy provider of medications may anticipate to be paid per unit.