CommercialPrior AuthMedium impact
Update to Commercial and ACA Medical Benefit Product Coverage for Medical Mutual Plans
Medical Mutual of Ohio·Allergy & Immunology, Hematology, Oncology +2 more·Medical Policy
Effective date
Aug 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 August 1, 2023. All IVIG requires prior authorization with step therapy documentation.
Action Required
Immediately: Update prior authorization workflows for all IVIG codes (J1554, J1572, J1561, J1569, J1566, J1557, J1568, J1459, J1556, J1599) to include step therapy documentation showing trial of two preferred products before non-preferred options. Train billing team to follow Medical Mutual prior authorization process for all IVIG requests and document medical necessity exceptions.