MedicaidPrior AuthMedium impact
5160-9-04 - Pharmacy services: drug utilization review. (Amend/Final File)
Ohio Medicaid·OH·Prior Authorization
Effective date
Feb 16, 2024
We identified it
Jun 20, 2026
Summary
Ohio Medicaid has amended its drug utilization review policy for pharmacy services, effective February 16, 2024. This policy update affects prior authorization requirements and review processes for medications covered under Ohio Medicaid.
Action Required
By February 16, 2024: Billing and clinical teams should review updated Ohio Medicaid drug utilization review requirements for pharmacy services. Verify current prior authorization processes align with amended policy 5160-9-04. Contact Ohio Department of Medicaid at 614-752-3877 for specific implementation guidance if treating Ohio Medicaid patients.