CommercialPrior AuthHigh impact
Update to Commercial and ACA Medical Benefit Product Coverage for Medical Mutual Plans - December 2023
Medical Mutual of Ohio·Hematology, Oncology, Neurology +3 more·Medical Policy
Effective date
Dec 1, 2023
We identified it
Jun 20, 2026
Summary
Medical Mutual now requires trial of two preferred IVIG products before non-preferred IVIG can be prescribed, effective December 1, 2023. All IVIG treatments require prior authorization, with specific preferred and non-preferred drug lists provided.
Action Required
Immediately: Billing team must update prior authorization processes for all IVIG medications (J1572, J1561, J1569, J1566, J1557, J1568, J1459, J1556, J1599, J1554) for Medical Mutual patients. Providers must document trial of two preferred IVIG products before prescribing non-preferred options. Update encounter forms to include step therapy documentation requirements. Claims will require prior authorization or will be denied.