MedicaidCoverageHigh impact
[Ohio] Pharmacy Policy Updates June 2026
CareSource·OH · Oncology, Hematology, Neurology +2 more·Pharmacy
Effective date
Sep 1, 2026
We identified it
Jun 6, 2026
Summary
CareSource Ohio Medicaid is updating 12 pharmacy policies effective September 1, 2026, including revised policies for specialty medications (ADZYNMA, AFLIBERCEPT, ECULIZUMAB, RITUXIMAB, SPINRAZA, SPRAVATO, UPLIZNA), oncology regimens, medical benefit medications, and one new policy for WASKYRA. Billing teams must review each updated policy for changes to prior authorization requirements, coverage criteria, and billing guidelines before the effective date.
Action Required
By August 31, 2026: Billing team must access each revised policy on CareSource.com (Providers > Tools & Resources > Provider Policies > Ohio Medicaid > Pharmacy) and document any changes to prior authorization requirements, coverage criteria, and approved indications for the following medications: ADZYNMA, AFLIBERCEPT (EYLEA, EYLEA HD, PAVBLU), ECULIZUMAB (SOLIRIS, EPYSQLI, BKEMV), MEDICAL BENEFIT MEDICATIONS, NULIBRY, ONCOLOGY REGIMENS, REBLOZYL, RITUXIMAB (RITUXAN, TRUXIMA, RUXIENCE, RIABNI), SPINRAZA, SPRAVATO, and UPLIZNA. Update billing system rules, encounter forms, and prior authorization workflows accordingly. For WASKYRA (new policy), establish new billing and authorization protocols. Failure to implement changes by September 1, 2026 will result in claim denials for non-compliant submissions.