Anthem BCBSMedium ImpactPrior Auth
[Ohio] Prior authorization and step therapy updates for medications billed under the medical benefit
Published May 14, 2026
AI Summary
Anthem has updated prior authorization and step therapy requirements for medications billed under the medical benefit in Ohio. This affects medications administered in-office that are typically billed with injection or infusion codes rather than pharmacy dispensed drugs.
Action Required
Immediately: Review the full policy bulletin at the provided URL to identify specific medications and codes affected. Update prior authorization workflows for medical benefit medications. Verify step therapy requirements are met before administering affected medications. Train clinical staff on new authorization requirements to prevent claim denials.
Plan Types
Commercial
States
OH
Specialties
rheumatology, oncology, gastroenterology, neurology, ophthalmology, dermatology, ortho