MedicaidPrior AuthHigh impact
5160-9-12 - Ohio department of medicaid (ODM) list of drugs covered without prior authorization. (Rescind/Final File)
Ohio Medicaid·OH·Prior Authorization
Effective date
Apr 1, 2017
We identified it
Jun 20, 2026
Summary
Ohio Department of Medicaid has rescinded rule 5160-9-12 which maintained a list of drugs covered without prior authorization. This rescission means there is no longer a specific list of drugs exempt from prior authorization requirements under Ohio Medicaid.
Action Required
Immediately: Billing team must assume ALL drug prescriptions for Ohio Medicaid patients now require prior authorization unless specifically exempted by other policies. Update billing workflows to obtain prior authorization for all medications before dispensing or administering drugs to Ohio Medicaid patients. Contact Ohio Medicaid at 614-752-3877 for current prior authorization requirements. Claims for drugs without proper prior authorization will be denied.