CommercialPrior AuthMedium impact
Update to Commercial and ACA Medical Benefit Product Coverage for Medical Mutual Plans - January 2021
Medical Mutual of Ohio·OH · Oncology, Hematology·Medical Policy
Effective date
Feb 4, 2021
We identified it
Jun 20, 2026
Summary
Medical Mutual is updating their preferred trastuzumab products list effective February 4, 2021, to include all available biosimilar versions as preferred drugs. Existing patients will need to try preferred drugs at prior approval renewal, and new patients must trial preferred drugs before non-preferred options can be prescribed.
Action Required
By February 4, 2021: Billing team must update prior authorization protocols for trastuzumab products. Update system to reflect Q5113, Q5117, Q5114, Q5112, and Q5116 as preferred drugs requiring step therapy before J9355 and J9356. Providers must follow Medical Mutual coverage determination process for non-preferred drug requests and document medical necessity or prior step therapy completion.