Prior Authorization in Ohio
Ohio enacted HB 135 (2019) requiring step therapy override protections. The law mandates exceptions when the required drug is contraindicated, was tried and failed, or is expected to be ineffective. Ohio also limits PA requirements for patients stable on chronic medications.
Key Facts About PA in Ohio
- ✓ Step therapy override protections with standard exception criteria
- ✓ Limits on PA requirements for stable chronic medication patients
- ✓ External review available through the Ohio Department of Insurance
- ✓ Ohio has significant Medicaid managed care with multiple MCOs
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in Ohio
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these Ohio carriers:
Anthem BCBS OhioUnitedHealthcareMedical Mutual of OhioAetna