MedicaidPrior AuthMedium impact
Pharmacogenomics Testing - MEDICAID - OHIO (New)
Humana·OH · Oncology, Hematology, Genetics +3 more·Medicaid
Effective date
Jun 25, 2025
We identified it
Jun 24, 2026
Summary
Humana Ohio Medicaid now covers specific pharmacogenomics tests (DPYD, NUDT15, TPMT) for guiding medication dosing or managing severe toxicity, while explicitly excluding numerous other genetic testing panels. This is a new policy establishing clear coverage criteria for genetic testing to optimize medication therapy.
Action Required
Before June 25, 2025: Billing team must update prior authorization system to require approval for all listed pharmacogenomics testing codes. Update provider encounter forms to indicate covered tests (81232, 81306, 84433) require prior auth with specific medical necessity documentation for fluoropyrimidine or thiopurine therapy. Train providers that 20+ excluded genetic testing panels will be denied. Claims submitted without prior authorization may be subject to retrospective review and denial.