MedicaidAdministrativeMedium impact
5160-26-13 - Managed health care programs: claim billing for pharmaceuticals. (New/Final File)
Ohio Medicaid·OH·Reimbursement
Effective date
Oct 1, 2022
We identified it
Jun 20, 2026
Summary
Ohio Department of Medicaid has issued a new rule (5160-26-13) establishing claim billing procedures for pharmaceuticals under managed health care programs. This rule became effective October 1, 2022 and creates new billing requirements for pharmaceutical claims submitted to Ohio Medicaid managed care plans.
Action Required
Review current pharmaceutical billing procedures for Ohio Medicaid managed care plans to ensure compliance with Rule 5160-26-13. Contact Ohio Department of Medicaid at 614-752-3877 for specific billing requirements and obtain the full rule text from the provided URL to understand detailed compliance obligations.