MedicaidCoverageMedium impact
[Ohio] Pharmacy Policy Updates March 2026
CareSource·OH · Pharmacy, Rheumatology, Neurology +4 more·Pharmacy
Effective date
Apr 1, 2026
We identified it
May 9, 2026
Summary
CareSource Ohio Medicaid is updating pharmacy policies for 10 medications effective April 1, 2026. Eight policies are revisions to existing coverage/prior authorization requirements, and two are new policies (Gazyva and Palsonify). Billing teams must review each medication's specific policy requirements to ensure accurate prior authorization submission and claim processing.
Action Required
By March 31, 2026: Billing team must access CareSource.com > Providers > Tools & Resources > Provider Policies, select Ohio Medicaid, then Pharmacy to review the full text of all 10 updated policies (Benlysta, Evkeeza, Gazyva, Immune Globulin, Leqembi, Leqvio, Palsonify, Saphnelo, Tysabri, Vyjuvek). Document any new prior authorization requirements, formulary restrictions, or coverage limitations. Update prior authorization templates and billing system rules accordingly. Flag prescribers who commonly use these medications and provide updated guidance. Failure to implement correct requirements may result in claim denials or delays.