A female pharmacist choses a prescription drug from a shelf in the pharmacy

Humana Healthy Horizons® in Ohio members get prescription drug coverage through Gainwell, Ohio Medicaid’s Single Pharmacy Benefit Manager (SPBM). Gainwell covers all Medicaid-covered, medically necessary prescription and over-the-counter (OTC) medications. Our members must use only Gainwell network pharmacies to get medications under the pharmacy benefit.

When filing electronic Medicaid claims, please use Payer ID 61103 for your patients with coverage through Humana Healthy Horizons in Ohio. Please do not use Humana’s traditional Payer ID for fee-for-service claims (61101) when submitting Humana Healthy Horizons in Ohio Medicaid claims. Learn more about filing electronic claims .

Drug coverage

At the  Gainwell website , you can find key information from Gainwell, or directions for accessing key information, including:

  • Provider Network Management Module
  • Contact information
  • Searchable Preferred Drug List
  • Drug coverage information
  • Provider communications
  • Prior authorization procedures and forms
  • Answers to frequently asked questions

Gainwell utilizes a uniform Preferred Drug List (PDL) and utilization management that the Ohio Department of Medicaid (ODM) develops. The PDL includes some preferred brands, as well as preferred diabetic supplies, such as blood glucose test strips, lancets, meters, and syringes. ODM will notify providers of changes to the PDL.

Medications on the PDL will have a $0 copayment when filled at a network pharmacy.

ODM Unified PDL

Medication Therapy Management

Humana offers a Medication Therapy Management (MTM) program that helps ensure patients achieve the best possible outcomes from their medications. The patient-centered MTM program promotes collaboration among the pharmacist, patient, and prescriber to optimize safe and effective medication use. The goal of this program is to optimize therapeutic outcomes by focusing on safety, effectiveness, lower-cost alternatives, and adherence.

Prescribers with questions about the program may call 888-210-8622 (TTY: 711), Monday – Friday, 8 a.m. – 7 p.m., Eastern time.

SPBM training opportunities

Gainwell Technologies, the Single Pharmacy Benefit Manager (SPBM), began providing pharmacy services across all managed care plans and for all members starting on October 1, 2022. Gainwell will offer several training opportunities for providers to gain knowledge that will benefit our members.

Trainings will cover several topics, including:

  • SPBM login and access
  • System navigation
  • Verifying member pharmacy benefit eligibility
  • Submitting and viewing pharmacy claims
  • Submitting and viewing pharmacy prior authorizations

Learn more about available SPBM training sessions

Ohio Medicaid

  • Humana Healthy Horizons in Ohio
  • Answers to FAQs
  • Availity
  • Clinical coverage policies
  • Behavioral health toolkit
  • Claims and payments
  • Clinical practice guidelines
  • Communications and network notices
  • Documents and resources
  • External medical review
  • Join our network
  • Optimization of pregnancy outcomes
  • Pharmacy
  • Prior authorization
  • Provider network management
  • Services for children
  • Telehealth services
  • Training materials