[Ohio] New specialty pharmacy medical step therapy requirements
AI Summary
Ohio Anthem has implemented new specialty pharmacy medical step therapy requirements, meaning patients must try certain lower-cost or first-line specialty medications before coverage is approved for more expensive alternatives. This will affect billing for specialty pharmaceutical claims and may require additional prior authorization steps.
Action Required
Immediately: Billing team should contact Ohio Anthem to obtain detailed step therapy protocols for specialty medications. Update prior authorization workflows to verify step therapy completion before submitting specialty pharmacy claims. Coordinate with providers to ensure patients have tried required first-line treatments before prescribing specialty medications. Monitor claim denials related to step therapy non-compliance.
Plan Types
Commercial
States
OH
Specialties
oncology, rheumatology, neurology, gastroenterology, dermatology, endocrinology