Ohio Department of Medicaid

The meeting included roll call and conflict-of-interest statement review. Updates were provided on Health Plan Policy, noting that the Pharmacy and Therapeutics (P&T) Committee met on October 8th, decisions on the Unified Preferred Drug List will be effective January 1st, 2026, and that the semiannual OAAC survey was completed. Dispensing fee changes were announced, including the sunset of the supplemental dispensing fee and a 9.6% increase in managed care dispensing fees, accompanied by an FAQ document. Staff promotions and new hires were also announced. Key discussion topics included potential new initiatives such as HIV medication adherence, long-term benzodiazepine use, appropriate antiplatelet use, and pediatric opioid prescribing. Several re-review interventions were presented, including CKD without ACE/ARB (resulting in a 14% increase in RASI therapy claims), HFREF without Beta Blocker (resulting in a 32% increase in beta blocker therapy claims), and Stimulants and CVD (resulting in an 8% decrease in ADHD stimulant claims). Recent interventions on Benzodiazepines and High Dose-Opioids, Anticholinergic Adverse Effects, and Migraine Prophylaxis were reviewed. A new intervention proposal for Atrial Fibrillation without Anticoagulation was presented. Monthly reports on Medication-Assisted Treatment (MAT) and the Coordinated Services Program (CSP) were also presented.

The meeting included the review of the conflict-of-interest statement and the annual re-approval of the by-laws. Elections were held, resulting in the nomination and approval of a new Chair and Vice Chair. Key discussions involved updates on the Next Generation MyCare program, which began implementation on January 1, 2026, and the recognition of the Ohio Department of Medicaid for the 2025 Spotlight Award for its comprehensive 'Next Generation' transformation. The Board discussed several past and new clinical initiatives for utilization review, including Gabapentin renal dosing, SGLT2-I in heart failure, duplicate serotonergic therapy, off-label use of antipsychotics in pediatrics, and OTC product coverage. Several re-review interventions were reported: Opioid and Antipsychotics (December 2024), The 'Holy Trinity' (January 2025), and HFrEF without ACE/ARB (February 2025), all showing significant positive results in prescriber adherence to guidelines. Recent interventions regarding Diabetes without Statin, Atrial Fibrillation without Anticoagulation, and Opioids and Antipsychotics (December 2025) were presented. A new intervention regarding Benzodiazepine Monotherapy was introduced and approved to proceed, with a suggestion to include benzodiazepine tapering guidelines in the prescriber letter. Updates were also provided on the Monthly Medication-Assisted Treatment (MAT) Report and the Coordinated Services Program Report.

The meeting agenda includes administrative matters such as roll call and conflict of interest statements, as well as health plan policy discussion and an annual by-law review. Key substantive topics involve elections and a deep review of past interventions regarding Opioids and Antipsychotics (December 2024), The "Holy Trinity" (January 2025), and HFrEF without ACE/ARB (February 2025). Recent interventions scheduled for review include Diabetes without Statin (October 2025) and Atrial Fibrillation without Anticoagulation (November 2025). A new intervention concerning Benzodiazepine Monotherapy for February 2026 is also planned. Reports are expected from the DUR Committee and regarding the Monthly MAT + Opioid Program, followed by announcements and calendar review.

This Population Health and Quality Strategy for the Ohio Department of Medicaid provides a comprehensive roadmap for improving healthcare quality and services for Medicaid beneficiaries from 2026 to 2028. It focuses on five programmatic goals: improving wellness and health outcomes, emphasizing personalized care, supporting providers, enhancing care for individuals with complex needs, and increasing program transparency and accountability. The strategy addresses five population health streams: Healthy Children and Adults, Women and Infant Health, Behavioral Health, Chronic Physical and Developmental Conditions, and Older Adults, aiming to ensure all beneficiaries receive appropriate, timely, and positive healthcare.

The meeting included a health plan policy update, a review and approval of previous DUR Board meeting minutes, and an open discussion on various topics, including HIV medication adherence, long-term benzodiazepine use, appropriate antiplatelet use, pediatric opioid prescribing, and opioids for dental pain. There was also a discussion on gabapentin use and re-reviews of interventions related to CKD without ACE/ARB, HFREF without Beta Blocker, and Stimulants and CVD. Recent interventions on Benzodiazepines and High Dose-Opioids, Anticholinergic Adverse Effects, and Migraine Prophylaxis were presented, along with a new intervention on Atrial Fibrillation without Anticoagulation. The Monthly Medication-Assisted Treatment (MAT) Report for October 2025 and the Coordinated Services Program Report were also presented. Announcements included the upcoming voting for chair and vice chair positions and a review of the bylaws at the February meeting. The 2025 intervention calendar and future meeting dates were reviewed.