MedicaidCoverageMedium impact
[Ohio] Clinical Criteria updates
Anthem BCBS·OH · Oncology, Hematology, Neurology +2 more·Provider Bulletin
Effective date
Sep 8, 2026
We identified it
Jun 13, 2026
Summary
Anthem Medicaid has updated clinical criteria for 29 specialty drugs, mostly oncology and immunology medications, with 2 new drug policies and 23 revised policies. These changes affect prior authorization requirements for high-cost specialty medications under the medical drug benefit.
Action Required
By September 8, 2026: Billing and prior authorization teams must review updated clinical criteria for 29 specialty medications including new drugs Forzinity and Inlexzo, and revised criteria for oncology drugs like Keytruda, Tecentriq, and immunology drugs like Tysabri. Visit Anthem's Clinical Criteria page to review specific medical necessity requirements for each drug. Update prior authorization workflows to reflect new criteria requirements.