Prior authorization (PA) is the process of obtaining additional information from the prescriber of a procedure, medication or service for the purpose of ensuring eligibility, benefit coverage, medical necessity, location and appropriateness of services. This tool is used by ODM to ensure safety of our beneficiaries and to help control costs.
Prescribers are encouraged to refer to the Prior Authorization and Step Therapy Frequently Asked Questions document to understand the PA and Step Therapy processes for the Ohio Medicaid FFS program. The Drug Coverage tab should also be referred to for the specific PA criteria on a given medication. Prescribers may sign up for notifications about criteria changes by referring to the PA Criteria Update History.
Requests for prior authorization can be made by phone by calling 1-877-518-1546 or by using the Request for Prior Authorization forms below and faxing them to 1-800-396-4111. PLEASE NOTE: Only the prescribing provider or a member of the prescribing provider's staff may request prior authorization in accordance with OAC 5160-9-03 (C)(3)*
- Compound PA Form
- Hepatitis C Direct Acting Antiviral Prior Authorization form
- Omnipod Prior Authorization form
- Opioid Prior Authorization form
- Standard Prior Authorization form
- Step Therapy Exemption Form
- Oral Medication Assisted Treatment of Opioid Use Disorder Prior Authorization Form
- Sublocade Prior Authorization form
- Synagis Prior Authorization form
* A pharmacist may request a prior authorization for an alternative dosage form of a drug to be administered to a patient who is tube fed.