Medicare AdvantagePrior AuthMedium impact
Update to Medical Benefit Drug Coverage for Medical Mutual Medicare Advantage Plans - December 2023
Medical Mutual of Ohio·Allergy & Immunology, Neurology, Hematology +2 more·Pharmacy
Effective date
Dec 1, 2023
We identified it
Jun 20, 2026
Summary
Medical Mutual Medicare Advantage plans now require trial of two preferred IVIG products before non-preferred IVIG can be prescribed for new patients. All IVIG medications require prior authorization with step therapy documentation.
Action Required
Immediately: Update prior authorization workflows to document step therapy requirements for IVIG medications. Billing team must ensure providers submit documentation showing trial of two preferred IVIG products (Flebogamma, Gamunex-C, Gammagard Liquid, Gammagard S/D, Gammaked, Gammaplex, Octagam, or Privigen) before requesting non-preferred products. Follow Medical Mutual prior authorization process for all IVIG requests. Claims may be denied without proper step therapy documentation.