MedicaidPrior AuthLow impact
[Ohio] Pharmacy Policy Updates February 2026
CareSource·OH · Infectious Disease, Internal Medicine·Pharmacy
Effective date
Mar 1, 2026
We identified it
May 9, 2026
Summary
CareSource Ohio Medicaid is removing prior authorization requirements for YEZTUGO (lenacapavir), effective March 1, 2026. This HIV treatment medication will now be available without prior auth, streamlining the prescription approval process for Ohio Medicaid members.
Action Required
By February 28, 2026: Billing and pharmacy staff should update internal prior authorization tracking systems to reflect that YEZTUGO (lenacapavir) no longer requires prior authorization for Ohio Medicaid claims. Remove any PA requirement flags from billing software and pharmacy management systems. Notify prescribers that this medication can now be submitted directly to the pharmacy without authorization delays. No claims will be denied for lack of prior auth on or after March 1, 2026.