Rule 5160-8-52. Services provided by a pharmacist

119.03 (A) Definition. "Pharmacist" has the same meaning as in Chapter 4729:1-1 of the Administrative Code. (B) Providers. An individual pharmacist may enroll in medicaid as a pharmacist provider. (C) Coverage. (1) Payment may be made only for a pharmacist service for which the following criteria are met: (a) The service is within a pharmacist's scope of practice; (b) The service is medically necessary in accordance with rule 5160-1-01 of the Administrative Code; (c) For a service rendered by prescription, the pharmacist provider obtains an order issued by a practitioner having appropriate prescriptive authority and maintains supporting documentation; and (d) The service is rendered for one of the following purposes: (i) Managing medication therapy under a consulting agreement with a prescribing practitioner pursuant to section 4729.39 of the Revised Code; (ii) Administering immunizations in accordance with section 4729.41 of the Revised Code; or (iii) Administering medications in accordance with section 4729.45 of the Revised Code. (2) Nothing in this rule precludes a medicaid managed care organization described in Chapters 5160-26 and 5160-58 of the Administrative Code from paying pharmacists for additional purposes, within scope of practice, including care management services that are rendered by a pharmacist without a consult agreement. (3) Payment may be made for covered telehealth services in accordance with rule 5160-1-18 of the Administrative Code. (4) Services may be rendered through a standing order or protocol as described in Chapter 4729. of the Revised Code. (D) Claim payment. (1) For a covered pharmacist service rendered at a federally qualified health center (FQHC) or rural health clinic (RHC), payment as an FQHC medical service or an RHC medical service is made in accordance with Chapter 5160-28 of the Administrative Code. (2) For a covered immunization, injection of medication, or provider-administered pharmaceutical, payment is made in accordance with rule 5160-4-12 of the Administrative Code. (3) For all other covered pharmacist services, payment is the lesser of the submitted charge or eighty-five per cent of the medicaid maximum amount specified in appendix DD to rule 5160-1-60 of the Administrative Code. (4) Payment for services rendered by a hospital-employed pharmacist will be made to the hospital. (5) In the event that payment for a covered service performed by a pharmacist is issued to both the hospital and the individual pharmacist, one of the issued payments is subject to recovery. Last updated January 5, 2026 at 8:48 AM Supplemental Information Authorized By: 5164.02 Amplifies: 5164.02 1/1/2031