CommercialPrior AuthHigh impact
Update to Commercial and ACA Medical Benefit Product Coverage for Medical Mutual Plans
Medical Mutual of Ohio·Rheumatology, Gastroenterology, Dermatology·Medical Policy
Effective date
Jun 15, 2022
We identified it
Jun 20, 2026
Summary
Medical Mutual has updated their preferred infliximab products list effective June 15, 2022. Avsola (Q5121) and Renflexis (Q5104) are now preferred drugs, while Inflectra (Q5103) and Remicade (J1745) are non-preferred and require prior authorization.
Action Required
Effective June 15, 2022: Billing team must update prior authorization requirements for infliximab products. Require prior auth for non-preferred drugs Inflectra (Q5103) and Remicade (J1745). Update billing system to flag these codes for prior authorization. Providers must try preferred drugs Avsola (Q5121) or Renflexis (Q5104) first for new patients, and existing patients must switch at renewal unless prior auth is obtained for medical necessity.