CommercialPrior AuthHigh impact
Formulary and Step Therapy Updates Effective July 1, 2019
Medical Mutual of Ohio·Pharmacy
Effective date
Jul 1, 2019
We identified it
Jun 20, 2026
Summary
Medical Mutual is updating their National Preferred/National Preferred Plus formulary and expanding step therapy requirements effective July 1, 2019. Certain medications will no longer be covered or change categories, and members must try preferred first-line drugs before accessing second-line medications that require prior authorization.
Action Required
By July 1, 2019: All staff must review the updated formulary exclusion list and new step therapy drug categories available through Medical Mutual's website. Providers must obtain prior authorization through Express Scripts portal (esrx.com/PA) or call 1-800-417-1764 for any second-line medications on the step therapy list. Update prescription workflows to check for Medical Mutual members with National Preferred/National Preferred Plus formularies and MedFlex plans before prescribing affected medications. Watch for letters from Medical Mutual in early June identifying affected patients.