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Ohio Medicaid releases guidance for COVID-19 testing by pharmacists

On June 29, the Ohio Department of Medicaid (ODM) released a memo that provides billing and reimbursement for pharmacies seeking to offer COVID-19 testing to patients. The memo follows recent remarks from Governor Mike DeWine seeking to expand access to testing at Ohio's pharmacies, as well as earlier moves from the State of Ohio Board of Pharmacy and U.S. Department of Health & Human Services that expanded the legal authority for pharmacists to order and administer the tests.

Both the Medicaid fee-for-service program and managed care program will be reimbursing pharmacies $23.46 per specimen collection.

The Department's guidance recommends for pharmacists to review the ODM website for payer specific information with instructions on how to submit a claim.

In a July 1 interview with the Ohio Capital Journal, ODM Director Maureen Corcoran explained that the $23.46 is intended to cover the protective equipment and service. According to the article, pharmacists can administer state-supplied tests and send them back to state testing facilities to be processed.

OPA is working to equip pharmacists with more logistical information and resources in order to effectively implement this service in their communities.

"Pharmacists are knowledgeable, trusted, and accessible healthcare professionals that should be utilized to provide COVID-19 testing for patients and much more," said Stu Beatty, OPA Director of Strategy and Practice Transformation. "Not only can pharmacists help expand testing for COVID-19, they can also help care for non-COVID patients being discharged from the hospital, needing immunizations and other preventive health, and adding another resource to help treat chronic diseases like diabetes and high blood pressure."

"We applaud Governor DeWine and Director Corcoran for tapping the expertise and accessibility of pharmacists to expand patient access to these needed tests," said OPA Executive Director Ernie Boyd.

In a June 30 media advisory, ODM stated,"Enabling pharmacies to be reimbursed for COVID testing is just one of several initiatives Ohio Medicaid has implemented since the start of the pandemic. The agency’s goal has been to ensure Medicaid beneficiaries have continued access to health care services while following preventative measures to reduce the risk of spreading the virus."

To view the Department's billing guidance, along with specimen collection NDCs, CLICK HERE.

For the Board of Pharmacy's rules that pharmacies must follow when conducting testing, CLICK HERE.

To view the Ohio Department of Health's testing guidance, CLICK HERE.

For the Ohio Medicaid fee-for-service payer sheet, CLICK HERE (Updated 7/2/20)

Please refer back to this page for more information on COVID-19 testing as it becomes available.

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