Changes to Prior Authorization Requests - November 2021

OhioHealth has a partnership with Archimedes, a healthcare solutions company, to ensure that those using the OhioHealthy Preferred Network (OhioHealth associates and their dependents) are receiving quality specialty care. As part of this endeavor, Archimedes and OhioHealth perform periodic reviews of the formulary.

Certain specialty medications and biosimilar agents require a prior authorization. Access the medical drug authorization forms to complete a request.

The following changes to the formulary will go into effect November 1, 2021.

Medications that will now require a prior authorization:

Drug Name Drug Code
Tecartus (brexucabtagene autoleucel) Q2053
Mometasone furoate sinus implant, 10 mcg J7401
Fensolvi (leuprolide acetate) J1951
Danyelza (naxitamab-gqgk) J9348
Kcentra (prothrombin complex) J7168
Margenza (margetuximab-cmkb) J9353
Oxlumo (lumasiran) J0224
Riabni (rituximab) Q5123

Medications that are no longer covered under the medical benefit:

Drug Name Drug Code
Uplizna (inebilizumab) J1823
Xolair (omalizumab) J2357
Tepezza(teprotumumab) J3241
Scenesse (afamelanotide) J7352
Vyondys 53 (golodirsen) J1429
Viltepso (viltolarsen) J1427

OhioHealth appreciates your partnership in helping maintain an affordable and sustainable benefit for its employees.