CommercialPrior AuthHigh impact
Update to Commercial and ACA Medical Benefit Product Coverage for Medical Mutual Plans - November 2020
Medical Mutual of Ohio·Oncology, Hematology, Rheumatology +2 more·Medical Policy
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
Medical Mutual is implementing step therapy requirements for multiple drug categories effective January 1, 2021. Members must try preferred medications before non-preferred drugs will be covered, with exceptions for certain conditions like Generalized Myasthenia Gravis and Neuromyelitis Optica Spectrum Disorders.
Action Required
Before January 1, 2021: Billing team must update prior authorization processes for Medical Mutual commercial and ACA plans to ensure step therapy requirements are met for hematological, inflammatory, oncology, ophthalmic, and osteoarthritis medications. Providers must document medical necessity when prescribing non-preferred drugs and follow Medical Mutual's coverage determination process. Update EMR templates to flag preferred vs. non-preferred medications listed in the policy chart.