← All states
OH
WISeR pilot

Ohio Prior Authorization Requirements

CHIPMedicare TraditionalMedicaid MCOMedicaid FFSMedicare AdvantageDual-EligibleCommercial (employer / fully-insured)Ohio Single PBM

PA required

76%

283 verified rules

Verified May 22, 2026

Service category PA

All programs combined
Durable Medical Equipment
10/10Full PA
pharmacy_standard
9/10Conditional
advanced_imaging
9/10Conditional
Physical Therapy
9/10Conditional
Home Health
9/10Conditional
Specialty Drugs
9/10Conditional
Inpatient Hospital
9/10Conditional
Outpatient Surgery
9/10Conditional
Behavioral Health — Inpatient
9/10Conditional
Behavioral Health — Outpatient
9/10Conditional
long_term_care
8/10Conditional
Skilled Nursing Facility
8/10Conditional
dental
1/10Conditional
hospice
0/10No PA

Drug class PA

Part D federal protections flagged
ImmunosuppressantsFed. Protected
8/9Conditional
Antipsychotics
7/8Conditional
Rare Disease / Orphan
7/8Conditional
Specialty Biologics
6/7Conditional
Brand (Generic Available)
6/7Conditional
Hepatitis C
6/7Conditional
ADHD Stimulants
6/7Conditional
Specialty Non-BiologicFed. Protected
6/7Conditional
Diabetes — Insulin
6/7Conditional
Brand (No Generic)
6/7Conditional
Diabetes — Non-Insulin
6/7Conditional
Controlled — Schedule II
6/7Conditional
Oral Oncology
6/7Conditional
Antidepressants
6/7Conditional
Controlled — Schedule III–V
6/7Conditional
Biosimilars
6/7Conditional
HIV Antiretrovirals
4/7Conditional
Opioid Treatment (MOUD)
3/5Conditional
glp1_diabetes
1/1Full PA
GLP-1 (Weight Loss)Fed. Protected
0/7No PA
Compounded MedicationsFed. Protected
0/7No PA

PA type breakdown

Full PA
137
Conditional
67
New starts only
8
clinical_criteria
4

Federal protected classes requiring PA

AntidepressantsPA required
AntipsychoticsPA required
Oral OncologyPA required
Oral OncologyPA required
ImmunosuppressantsPA required
AntipsychoticsPA required
AntidepressantsPA required
ImmunosuppressantsPA required

State flags

Medicaid expansion state
WISeR pilot (high data quality)
FFS-dominant (minimal MCO)

Look up a specific PA rule for Ohio

Type a drug brand or service. Pick a program. Get the verdict, source URL, and confidence score in under 300ms.

Look up a OH rule →← All states