Ohio Plan Analysis

Plan analysis

Before October first, when the Federal Marketplace opened, the Ohio AIDS Coalition sought to obtain an in-depth analysis of Marketplace plans for Ohioans living with HIV.  Working with professional Evaluator Lennise Baptiste, of Sandra Ortega Consulting, OAC has compiled a document that identifies HIV drug and provider gaps for every Marketplace plan.  In this document you will find:

  • A summary of the drugs that are excluded from each insurance provider’s drug formulary with broader observations and additional notes
  • An in-depth drug identification for each of the twelve insurance provider’s formularies
    • Each tab is devoted to a different provider, with a key to the right and notes at the bottom of each page.
    • Every drug has been checked in both generic and brand name
    • Some providers have suggested that plans may not adhere to the formulary, check the notes section for clarification.
  • Ryan White Essential Community Provider list
    • In alphabetical order, Ryan White providers with billing address, city, tax ID (EIN), and practice address (some may differ from billing)
    • By column, scrolling right you can identify if a Ryan White provider is covered under each insurer.
    • Providers may be added, removed, or edited as needed
  • Ohio Medicaid Formulary Analysis for Managed Care Plans
    • These are for the 5 Managed Care insurance providers in the State, which are available in every region
    • Managed Care is offered to the newly covered individuals through Medicaid Extension.  Not all previous groups are eligible to receive Managed Care, though plans are in the works to extend these benefits in the future
    • Always make a final check with the insurer to determine that all of your medications are covered at an acceptable level

Disclaimer:  This analysis is meant to be used as a tool for guidance and serves merely as a snapshot in time.  Because provider networks constantly fluctuate, the Provider Analysis should be primarily used as a tool for advocacy. Consumers must continue to self-advocate by examining each plan and determining if it is right for them.  Before selecting a plan, all individuals should contact the plan provider to confirm the accuracy of all information. As plans change through our advocacy efforts we will attempt to keep this up-to-date.

Any discrepancies found within these documents should be reported to OAC so that the documents can reflect accurate information.

OHIO PLAN ANALYSIS  (Up to date 3/06/14)