Medicare AdvantagePrior AuthMedium impact
Update to Medical Benefit Drug Coverage for Medical Mutual Medicare Advantage Plans
Medical Mutual of Ohio·Oncology, Hematology·Pharmacy
Effective date
Oct 1, 2022
We identified it
Jun 20, 2026
Summary
Effective October 1, 2022, Medical Mutual Medicare Advantage Plans eliminated prior authorization requirements for six cancer medications: Adcetris, Alimta, Faslodex, Halaven, Velcade, and Trisenox. Billing teams can now submit claims for these drugs without obtaining prior authorization approval.
Action Required
Immediately: Billing team must update prior authorization workflow to remove pre-approval requirements for Adcetris (brentximab vedotin), Alimta (pemetrexed), Faslodex (fulvestrant), Halaven (eribulin), Velcade (bortezomib), and Trisenox (arsenic trioxide) for Medical Mutual Medicare Advantage patients. Update billing system rules and staff training materials to reflect these medications no longer require prior authorization.