Pharmacist participation as providers in Ohio Medicaid: an analysis of claims, services, and billing patterns,...

States increasingly recognize pharmacists as medical-benefit providers, yet participation under Medicaid is not well documented.

We conducted a retrospective descriptive analysis of pharmacist-submitted claims to the Ohio Department of Medicaid from January 2017 to January 2025. Claims included current procedural terminology/International Classification of Diseases-10 codes, paid/denied status, payment amounts, and place of service.

Pharmacists submitted 1424 claims before implementation and nearly 250 000 afterward, with more than 85% paid and $4.4 million reimbursed. Most claims occurred in team-based settings (Federally Qualified Health Centers [55%] and office practices [41%]) while community pharmacy billing was rare (0.19%). Common services included evaluation and management visits, preventive counseling, and continuous glucose monitoring; leading diagnoses were type 2 diabetes, hypertension, and nicotine dependence.

Recognition of pharmacists as medical-benefit providers produced rapid participation at modest cost, primarily in integrated clinical settings. These findings suggest that streamlined referral processes and improved billing support may expand participation, particularly in community pharmacies.