CommercialPrior AuthMedium impact
Update to Commercial and ACA Medical Benefit Product Coverage for Medical Mutual Plans - May 2021
Medical Mutual of Ohio·Oncology, Hematology·Medical Policy
Effective date
Aug 1, 2021
We identified it
Jun 20, 2026
Summary
Medical Mutual has updated their preferred pegfilgrastim products list effective August 1, 2021. Members on existing therapy must try preferred drugs at prior approval renewal, and new members must trial preferred drugs before non-preferred options can be prescribed.
Action Required
By August 1, 2021: Billing team must update prior authorization processes for pegfilgrastim products. Ensure providers are aware that Nyvepria (Q5122), Udenyca (Q5111), and Ziextenzo (Q5120) are now preferred products along with existing Fulphila (Q5108) and Neulasta (J2505). Update billing system to flag when non-preferred pegfilgrastim products require step therapy documentation and prior authorization through Medical Mutual's coverage determination process.