MedicaidPrior AuthHigh impact
[Ohio] Action needed: Medicaid providers — PA required for certain medical benefit drugs
Anthem BCBS·OH·Government Programs
We identified it
May 3, 2026
Summary
Ohio Medicaid now requires prior authorization for certain medical benefit drugs. This is an immediate change affecting Medicaid providers who prescribe or bill for these medications.
Action Required
Immediately: Billing team and providers must identify which medical benefit drugs now require prior authorization by reviewing the Anthem provider portal. Update billing workflows to verify prior authorization status before submitting claims for affected drugs. Configure billing system alerts to flag these medications. Failure to obtain required prior authorization will result in claim denials.