MedicaidPrior AuthMedium impact
[Ohio] Prior authorization and step therapy updates for medications billed under the medical benefit
Anthem BCBS·OH · Oncology, Rheumatology, Ophthalmology +1 more·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
Jun 13, 2026
Summary
Effective July 1, 2026, Anthem Blue Cross and Blue Shield Medicaid in Ohio will require prior authorization for seven new specialty pharmacy drugs billed under medical benefits, including Boncresa, Lerochol, Nufymco, Oziltus, Rybrevant Faspro, Yartemlea, and Zycubo. Additionally, Nufymco will be subject to step therapy requirements during prior authorization review.
Action Required
Before July 1, 2026: Billing team must update prior authorization workflows for seven specialty drugs (Boncresa, Lerochol, Nufymco, Oziltus, Rybrevant Faspro, Yartemlea, and Zycubo) for Ohio Medicaid patients. Ensure all medical claims include National Drug Code (NDC) numbers for proper processing. Review Clinical Criteria website for specific authorization requirements (CC-0027, CC-0299, CC-0072, CC-0201, CC-0298, CC-0297). Note that patients currently receiving these medications may need new prior authorization for continued treatment.