MedicaidCoverageMedium impact
[Ohio] Pharmacy Policy Updates April 2025
CareSource·OH · Pharmacy·Pharmacy
Effective date
Apr 11, 2025
We identified it
May 9, 2026
Summary
Effective April 11, 2025, KEBILIDI (eladocagene exuparvovec-tneq) coverage has been carved out from CareSource Ohio Medicaid and transferred to the Ohio Department of Medicaid. This means claims for this medication will no longer be processed by CareSource and must be submitted to the state Medicaid program instead.
Action Required
By April 10, 2025: Billing team must identify any pending or active claims for KEBILIDI (eladocagene exuparvovec-tneq) for Ohio Medicaid patients and redirect them to the Ohio Department of Medicaid for processing. Update internal billing system notes and payer routing logic to ensure future KEBILIDI claims are routed to Ohio Department of Medicaid, not CareSource. Contact CareSource for submission procedures and any required prior authorization requirements under state administration. Verify with pharmacy if any patient prescriptions are affected and communicate changes to providers prescribing this gene therapy medication. Failure to route claims correctly will result in denials from CareSource.