CommercialPrior AuthMedium impact
Update to Commercial and ACA Medical Benefit Product Coverage for Medical Mutual Plans
Medical Mutual of Ohio·Oncology, Hematology·Medical Policy
Effective date
Oct 1, 2022
We identified it
Jun 20, 2026
Summary
Effective October 1, 2022, Medical Mutual no longer requires prior authorization for 8 specific cancer medications including Abraxane, Adcetris, Alimta, Faslodex, Halaven, Trisenox, Velcade, and Xgeva under commercial and ACA medical benefit plans. This streamlines the billing process for these oncology drugs by removing the prior auth barrier.
Action Required
Immediately: Billing team must update prior authorization requirements in billing system to remove prior auth for Abraxane, Adcetris, Alimta, Faslodex, Halaven, Trisenox, Velcade, and Xgeva for Medical Mutual commercial and ACA plans. Update encounter forms and notify providers that these 8 cancer medications no longer need prior authorization approval before prescribing or billing.