MedicaidCoverageMedium impact
[Ohio] Pharmacy Policy Updates April 2025
CareSource·OH · Oncology, Ophthalmology, Endocrinology +1 more·Pharmacy
Effective date
May 1, 2025
We identified it
Jun 13, 2026
Summary
CareSource Ohio Medicaid has updated pharmacy policies for 6 drug categories effective May 1, 2025, including new coverage for DARZALEX FASPRO and revised policies for AFLIBERCEPT, EVKEEZA, multi-source brands, POMBILITI/OPFOLDA, and SPRAVATO. These changes affect prior authorization requirements and coverage criteria for specialty medications.
Action Required
By May 1, 2025: Billing team must review updated CareSource Ohio Medicaid pharmacy policies at CareSource.com > Providers > Tools & Resources > Provider Policies for the 6 affected drug categories. Update prior authorization processes and coverage criteria for AFLIBERCEPT, DARZALEX FASPRO, EVKEEZA, multi-source brands, POMBILITI/OPFOLDA, and SPRAVATO. Verify current authorization requirements before prescribing or billing for these medications to avoid claim denials.