Notice of Changes to Prior Authorization Requests
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 September 1, 2021.
Medications that will now require a prior authorization:
| Drug Name | Drug Code |
| Onivyde (irinotecan liposome) | J9205 |
| Poteligeo (mogamulizumab-kpkc) | J9204 |
| Evenity (romosozumab-aqqg) | J3111 |
| Onpattro (patisiran) | J0222 |
| Ultomiris (ravulizumab-cwvz) | J1303 |
| Mometasone sinus sinuva | J7402 |
| Blenrep (belantamab mafodont blmf) | J9037 |
| Infugem (gemcitabine) | J9198 |
| Monjuvi (tafasitamab-cxix) | J9349 |
| Nyvepria (pegfilgrastim) | Q5122 |
| Simponi (golimumab) | J1602 |
Medications that are no longer covered under the medical benefit:
| Drug Name | Drug Code |
| Makena (hydroxyprogesterone caproate) | J1729 |
| Makena (HYDROXYprogesterone) | J1725 |
| Makena (HYDROXYprogesterone) | J1726 |
| Makena (HYDROXYprogesterone) | J1729 |
| Makena (HYDROXYprogesterone) | Q9885 |
| Makena (HYDROXYprogesterone) | Q9986 |
| Supprelin LA (histrelin acetate) | J9226 |
| Enhertu (fam-trastuzumab deruxtecan-nxki) | J9358 |
| Xembify (immune globulin) | J1558 |
| Libtayo (cemiplimab-rwlc) | J9119 |
| Sarclisa (isatuximab-irfc) | J9227 |
| Asceniv (immune globulin) | J1554 |
| Cutaquig (immune globulin) | J3590 |
| Padcev (enfortumab vedotin-ejfv) | J9177 |
| Beovu (brolucizumab-dbll) | J0179 |
| Stelara (ustekinumab) SUBQ | J3357 |
OhioHealth appreciates your partnership in helping maintain an affordable and sustainable benefit for its employees.
