MedicaidCoverageMedium impact
[Ohio] Pharmacy Policy Updates January 2025
CareSource·OH · Oncology, Hematology·Pharmacy
Effective date
Nov 26, 2024
We identified it
May 9, 2026
Summary
Two gene therapy products (LENMELDY and BEQVEZ) have been carved out from CareSource Ohio Medicaid coverage as of November 26, 2024, and transferred to the Ohio Department of Medicaid for direct management. Billing teams must route claims for these therapies to the state Medicaid program rather than CareSource.
Action Required
By December 31, 2024: Billing team must update claim routing procedures to identify claims for LENMELDY (atidarsagene autotemcel) and BEQVEZ (fidanacogene elaparvovec-dzkt) and submit them directly to the Ohio Department of Medicaid instead of CareSource. Update billing system notes and provider communication to flag these drugs as state-managed. Confirm with CareSource that claims submitted to them for these therapies after 11/26/2024 will be denied and must be resubmitted to the state program. Failure to reroute claims will result in denial and delayed reimbursement.