CommercialPrior AuthMedium impact
[Ohio] Expansion of the specialty pharmacy precertification list
Anthem BCBS·OH·Pharmacy
We identified it
May 3, 2026
Summary
Anthem Ohio has expanded their specialty pharmacy precertification list, meaning more specialty medications now require prior authorization before they can be dispensed. This affects billing for specialty drugs that previously did not need pre-approval.
Action Required
Immediately: Billing team should access the updated precertification list at the provided URL to identify which specialty medications now require prior authorization. Update billing workflows to verify prior auth status before dispensing newly added specialty drugs. Train staff to check precertification requirements for all specialty pharmacy medications to avoid claim denials.