Medicare AdvantagePrior AuthMedium impact
Update to Medical Benefit Drug Coverage for Medical Mutual Medicare Advantage Plans
Medical Mutual of Ohio·Allergy & Immunology, Neurology, Hematology +2 more·Pharmacy
Effective date
Aug 1, 2023
We identified it
Jun 20, 2026
Summary
Medical Mutual Medicare Advantage plans now require step therapy for IVIG medications effective August 1, 2023. New patients must trial two preferred IVIG products before non-preferred products can be prescribed, and all IVIG requires prior authorization.
Action Required
Immediately: Update billing system to require prior authorization for all IVIG codes (J1554, J1556, J1557, J1559, J1561, J1566, J1568, J1569, J1572, J1599). Train providers to document step therapy compliance or medical necessity justification for non-preferred products when submitting prior authorization requests. Update encounter forms to include preferred IVIG options list.