Notice Date: June 16, 2026To: All Marketplace ProvidersFrom: CareSource Subject: Prior Authorization Requirement Update Effective Date: August 1, 2026 Notification of prior authorization requirement updates, effective August 1, 2026:Detailed code-level changes are listed in Addendum A (see the following page).Prior authorization is required for all nonparticipating providers and for inpatient service requests. Authorization approval and/or payment may depend on factors including, but not limited to: Member eligibility Members younger than 21 years old Medical necessity Covered benefits Modifiers Diagnosis and revenue codes Limits and number of visit variances Provider contracts Provider types Correct coding and billing practices ImportanceProviders can check prior authorization requirements at any time by searching for CPT or HCPCS codes in the CareSource Procedure Lookup Tool. Questions?For questions, contact your Provider Engagement Representative or Provider Services at 1-833-230-2101 , Monday through Friday, 8:00 a.m. to 6:00 p.m. Eastern Time (ET) and Pacific Time (PT ) for Nevada. Addendum A: New Codes Requiring Prior AuthorizationCategory Codes Durable Medical Equipment A4295, A4296, A4297, C1608, C9811, C9815, C9816, C9817, Q4398, Q4399, Q4400, Q4401, Q4402, Q4403, Q4404, Q4405, Q4406, Q4407, Q4408, Q4409, Q4410, Q4411, Q4412, Q4413, Q4414, Q4415, Q4416, Q4417, Q4420, Q4431, Q4432, Q4433 Hearing Services 92631, 92632 Inpatient Facility Services 27458, 27713, 33882, 35602, 43889, 64654, 64655, 64656, 64657, 64658, 64659 Outpatient Diagnostics 0602U, 0603U, 0604U, 0605U, 0606U, 0607U, 0608U, 0609U, 0611U, 0612U, 0613U, 0999T, 1000T, 1001T, 37263, 37264, 37265, 37266, 37267, 37268, 37269, 37270, 37271, 37272, 37273, 37274, 37275, 37276, 37277, 37278, 37280, 37281, 37282, 37283, 37284, 37285, 3728 6, 37287, 37288, 37289, 37290, 37291, 37292, 37293, 37294, 37295, 37296, 37297, 37298, 37299, 70471, 70472, 70473, 77436, 81524, 92930, 92945 Outpatient Services (Facility/Professional) 0988T, 0990T, 0994T, 0995T, 1003T, 1013T, 1014T, 1015T, 1019T, 37254, 37255, 37256, 37257, 37258, 37259, 37260, 37261, 37262, 37279, 47384, 52443, 52597, 55868, 55869, 55877, 62330, 62331, 63032, 64567, 64728, 77437, 77438, 77439, 81354, C7566, C9810, G057 1 Multi-EXC-P-5512380
Notice Date: June 16, 2026To: CareSource MyCare Ohio (HMO D-SNP) ProvidersFrom: CareSource Subject: Prior Authorization Requirement Update Effective Date: August 1, 2026 SummaryNotification of prior authorization requirement updates effective August 1, 2026:Detailed code-level changes are listed in Addendum A (see the following page).Prior authorization is required for all nonparticipating providers and for inpatient service requests. Authorization approval and/or payment may depend on factors including, but not limited to: Member eligibility Member age (younger than 21 years) Medical necessity Covered benefits Applicable modifiers Diagnosis and revenue codes Service limits and visit limits Provider contracts Provider type Correct coding and billing practices ImportanceProviders may verify prior authorization requirements at any time by searching for CPT or HCPCS codes in the CareSource Procedure Lookup Tool. Questions?For questions, contact your Provider Engagement Representative or Provider Services at 1-800-488-0134, Monday through Friday, 8:00 a.m. to 6:00 p.m. Eastern Time (ET). Addendum A: New Codes Requiring Prior Authorization Category Codes Durable Medical Equipment A4295, A4296, A4297, C1608, C9811, C9815, C9816, C9817, Q4398, Q4399, Q4400, Q4401, Q4402, Q4403, Q4404, Q4405, Q4406, Q4407, Q4408, Q4409, Q4410, Q4411, Q4412, Q4413, Q4414, Q4415, Q4416, Q4417, Q4420, Q4431, Q4432, Q4433 Hearing Services 92631, 92632 Inpatient Facility Services 27458, 27713, 33882, 35602, 43889, 64654, 64655, 64656, 64657, 64658, 64659 Outpatient Diagnostics 0602U, 0603U, 0604U, 0605U, 0606U, 0607U, 0608U, 0609U, 0611U, 0612U, 0613U, 0999T, 1000T, 1001T, 37263, 37264, 37265, 37266, 37267, 37268, 37269, 37270, 37271, 37272, 37273, 37274, 37275, 37276, 37277, 37278, 37280, 37281, 37282, 37283, 37284, 37285, 3728 6, 37287, 37288, 37289, 37290, 37291, 37292, 37293, 37294, 37295, 37296, 37297, 37298, 37299, 70471, 70472, 70473, 77436, 81524, 92930, 92945 Outpatient Services (Facility/Professional) 0988T, 0990T, 0994T, 0995T, 1003T, 1013T, 1014T, 1015T, 1019T, 37254, 37255, 37256, 37257, 37258, 37259, 37260, 37261, 37262, 37279, 47384, 52443, 52597, 55868, 55869, 55877, 62330, 62331, 63032, 64567, 64728, 77437, 77438, 77439, 81354, C7566, C9810, G057 1 H6396_OH-SNP-P-5513201_C
I wi Notice Date: June 16, 2026 To: GA Medicaid Providers From: CareSource Subject: Prior Authorization Requirement Update Effective Date: August 1, 2026 Impact Notification of prior authorization requirement updates effective August 1, 2026. Detailed code-level changes are listed in Addendum A (see the following page). Prior authorization is required for all nonparticipating providers and for inpatient service requests. Authorization approval and/or payment may depend on factors including, but not limited to: Member eligibility Member age (younger than 21 years) Medical necessity Covered benefits Applicable modifiers Diagnosis and revenue codes Service limits and visit limits Provider contracts Provider type Correct coding and billing practices Importance Providers may verify prior authorization requirements at any time by searching for CPT or HCPCS codes in the CareSource Procedure Lookup Tool . Questions? For questions, contact your Provider Engagement Representative or Provider Services at 1-855-202-1058. We are open Monday through Friday, 7:00 a.m. to 7:00 p.m., Eastern Time (ET).Addendum A: New Codes Requiring Prior AuthorizationCategory Codes Durable Medical Equipment A4295, A4296, A4297, C1608, C9811, C9815, C9816, C9817, Q4398, Q4399, Q4400, Q4401, Q4402, Q4403, Q4404, Q4405, Q4406, Q4407, Q4408, Q4409, Q4410, Q4411, Q4412, Q4413, Q4414, Q4415, Q4416, Q4417, Q4420, Q4431, Q4432, Q4433 Hearing Services 92631, 92632 Inpatient Facility Services 27458, 27713, 33882, 35602, 43889, 64654, 64655, 64656, 64657, 64658, 64659 Outpatient Diagnostics 0602U, 0603U, 0604U, 0605U, 0606U, 0607U, 0608U, 0609U, 0611U, 0612U, 0613U, 0999T, 1000T, 1001T, 37263, 37264, 37265, 37266, 37267, 37268, 37269, 37270, 37271, 37272, 37273, 37274, 37275, 37276, 37277, 37278, 37280, 37281, 37282, 37283, 37284, 37285, 37286, 37287, 37288, 37289, 37290, 37291, 37292, 37293, 37294, 37295, 37296, 37297, 37298, 37299, 70471, 70472, 70473, 77436, 81524, 92930, 92945 Outpatient Services (Facility/Professional) 0988T, 0990T, 0994T, 0995T, 1003T, 1013T, 1014T, 1015T, 1019T, 37254, 37255, 37256, 37257, 37258, 37259, 37260, 37261, 37262, 37279, 47384, 52443, 52597, 55868, 55869, 55877, 62330, 62331, 63032, 64567, 64728, 77437, 77438, 77439, 81354, C7566, C9810, G057 1 GA-MED-P- 5534889 DCH Approved: 6/5/2026
Claims Payment Systemic Errors (CPSE) Update Report Confidential and Proprietary As of: June 16, 2026Listed below are current CPSE. This log is updated monthly. Please review this log for CPSE updates on status, target dates for reprocessing and resolutions. If you have questions after reviewing the log, please call Health Partner Services at 1-84 4-607-2831. Unique ID and Description of CPSEThe date(s) of service of claims impacted Timeline for Fixing CPSE Date(s) and/or Date Span(s) of Corrected Claims AdjustmentsUnique ID CSO0707296:Confirmed CPSELaboratory claims billed with procedure codes 80305-80307 paid and requires prior authorization after 52 units per calendar year per the Indiana Health Coverage Programs (IHCP) Bulletin BT202183. Claims billed with procedure codes (see below) paid and requires prior authorization after 16 units per calendar year per the Indiana Health Coverage Programs (IHCP) Bulletin BT202183. This is a potential overpayment to claims. Codes included:G0480, G0481, G0659 1/1/2024 to 12/31/20254/20/2026 4/23/20264/27/2026Target claims reprocessing date 5/18/2026-5/25/2026 Target claims reprocessing date 6/17/2026-6/24/2026Unique ID CSO0729068:Confirmed CPSEProfessional and outpatient facility claims billed with procedure codes (see below) more than one time per member per day denied u02 (Max Frequency exceeded) and should pay. This is a potential underpayment to claims. Codes included:87275, 87276, 87400, 87501, 87502, 87804 2/25/2026 to 3/31/20264/16/2026Target claims reprocessing date 5/13/2026-5/20/2026 Claims reprocessed on 5/22/2026 Confidential and ProprietaryIN-MED-P-5697401
Claims Payment System ic Errors (CPSE) Update Report Confidential and Proprietary As of: June 15, 2026 Listed below are current CPSE. This log is updated monthly. Please review this log for CPSE updates on status, target dates for reprocessing and resolutions. If you have questions after reviewing the log, please call Provider Services at 1-8 00-488-0134. Unique ID and Description of CPSE Line of Business Date CPSE was First Identified Billing Provider Type(s) Impacted by CPSE (select all that apply) Timeline for Fixing CPSE Date(s) and/or Date Span(s) of Corrected Claims Adjustments CPSE Status Unique ID CSO0686774:Confirmed CPSEBehavioral Health claims billed with diagnosis codes (See Below) denied 9NP (Service not payable for provider), XIR (Invalid diagnosis code submitted) and XPS (Service not payable for provider) and should pay. This is a potential underpayment to claims.Codes Included:F1090,F1091,F1191,F1291,F1491,F4381,F4389 Medicaid 1/23/2026 37-Licensed Independent Social Worker (LISW)42-Psychologist, Individual53-Behavior Analyst84-Ohio Department of Mental Health (Community Mental Health) Provider95-ODADAS Certified/Licensed (SUD) Treatment Program96-Paraprofessional 3/12/20263/23/20264/9/20264/22/20264/20/2026 Target Claims reprocessing date 6/4/2026-6/11/2026Target Claims reprocessing date 6/16/2026-6/23/2026 In Process Unique ID CSO069744:Confirmed CPSEOhio Department of Medicaid (ODM) direction received that Rehabilitation, Long term acute care (LTAC), and Cancer hospitals that reimburse at cost to share ratio (CCR) shall have payment of 90% or 91.7% of CCR. This is a potential overpayment/underpayment to claims. Medicaid 1/29/2026 01-Hospital (Inpatient) 2/19/20262/26/20262/25/20264/23/2026 Target Claims reprocessing date 5/21/2026-5/28/2026Claims reprocessed on 5/12/2026 Completed Unique ID CSO0697235:Confirmed CPSEEffective 1/1/2026 vision claims billed with diagnosis codes (see below) paid and should have denied to submit claims to EyeMed. This is a potential overpayment to claims. Codes included:H52.00, H52.01, H52.02, H52.03, H52.10, H52.11, H52.12, H52.13, H52.201, H52.202, H52.203, H52.209, H52.211, H52.212, H52.213, H52.219, H52.221, H52.222, H52.223, H52.229, H52.31, H52.32, H52.4, H52.521, H52.522, H52.523, H52.529, H52.531, H52.532, H52.533, H52.539, H52.6, H52.7, H53.141, H53.142, H53.143, H53.149, H53.50, Z01.00, Z01.01, Z01.020, Z01.021, Z46.0, Z97.3 Medicaid & MyCare 3/9/2026 20-Physician/Osteopath, Individual35-Optometrist, Individual75-Optician 4/13/20264/20/20264/13/20264/15/2026 Target Claims reprocessing date 5/11/2026-5/18/2026Claims reprocessed on 5/18/2026 Completed Unique ID CSO0723827:Confirmed CPSENot CPSEProfessional claims billed with procedure code S5136 (Companion care, adult (e.g., IADL/ADL); per diem) paid without an authorization and should have denied. This is a potential overpayment to claims MyCare 3/26/2026 45-Waivered Services Organization55-Waivered Services, Individual 4/16/20264/15/2026 Target Claims reprocessing date 5/14/2026-5/21/2026 Removed from log Unique ID CSO0715872:Confirmed CPSEProfessional claims were being reimbursed from the Qualified Provider Fee Schedule and should have been reimbursed from the CMS Physician Resource-Based Relative Value Scale Fee schedule. This is a potential overpayment/underpayment to claims. MyCare 3/27/2026 20-Physician/Osteopath, Individual 4/29/20265/4/20265/6/2026 Target Claims reprocessing date 5/20/2026-5/27/2026Target Claims reprocessing date 6/16/2026-6/23/2026 In Process Unique ID CSO0714121:Confirmed CPSEProfessional claims billed with procedure code 90785 "Interactive complexity (List separately in addition to the code for primary procedure)" denied Z50 (Medicare Non-Covered Service) and should pay. This is a potential underpayment to claims. MyCare 3/27/2026 20-Physician/Osteopath, Individual37-Licensed Independent Social Worker (LISW)52-Independent Marriage and Family Therapist54-Licensed Independent Chemical Dependency Counselor72-Nurse Practitioner, Individual 4/15/20264/11/2026 Target Claims reprocessing date 5/11/2026-5/18/2026Claims reprocessed on 5/14/2026 Completed Unique ID CSO0732140:Confirmed CPSEOutpatient Facility Renal claims were reimbursed at an old contracted rate and should have been reimbursed at the amended contractual rate effective 2/1/2026. This is a potential overpayment/underpayment to claims. Medicaid & MyCare 4/7/2026 59-End-Stage Renal Disease (Dialysis) Clinic 5/1/20265/28/20266/4/20266/11/20266/10/2026 Target Claims reprocessing date 6/25/2026-7/2/2026Target Claims reprocessing date 7/2/2026-7/9/2026 In Process Unique ID CSO0725940:Confirmed CPSEHospice claims billed with procedure codes T2042 (Hospice routine home care; per diem) and T2043 (Hospice continuous home care; per hour) and not billed with the Value code 61 paid and should have denied. Procedure codes T2044 (Hospice inpatient respite care; per diem) and T2045 (Hospice general inpatient care; per diem) billed without the Value code G8 paid and should have denied. This is a potential overpayment to claims. Medicaid & MyCare 4/9/2026 44-Hospice 5/6/20265/7/20265/14/20265/21/20265/14/2026 Target Claims reprocessing date 6/3/2026-6/10/2026Target Claims reprocessing date 6/17/2026-6/24/2026 In Process Unique ID CSO0696875:Confirmed CPSEProfessional claims billed with procedure code T1019 Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant) and T1001 Nursing assessment/evaluation together on the same claim paid and the entire claim should have denied. This is a potential overpayment to claims. MyCare 4/15/2026 45-Waivered Services Organization55-Waivered Services, Individual 5/6/2026 Target Claims reprocessing date 6/3/2026-6/10/2026Claims reprocessed on 6/10/2026 Completed Unique ID CSO0741447:Confirmed CPSEGenetic testing procedure codes (see below) denied X94 (Service requires authorization) and should pay. This is a potential underpayment to claims. Genetic testing procedure code 81381 paid and should have denied for no authorization. This is a potential overpayment to claims. Codes included:81220, 81335, 81401 Medicaid & MyCare 4/21/2026 80-Independent Laboratory 5/18/2026 Target Claims reprocessing date 6/15/2026-6/22/2026 Claims reprocessed on 6/9/2026 Completed Unique ID CSO0702213:Confirmed CPSEProcedure codes A4453 "Rectal catheter with or without balloon, for use with any type transanal irrigation system, each" and B4104 "Additive for enteral formula (e.g., fiber)" denied X99 (Not a covered service/procedure) and should have paid as of 1/1/26. This is a potential underpayment to claims. Medicaid & MyCare 4/29/2026 76-Durable Medical Equipment Supplier 5/28/20265/27/2026 Target Claims reprocessing date 6/25/2026-7/2/2026 In Process Unique ID CSO07414985:Confirmed CPSEInpatient lab codes (see below) paid without applying member responsibility. This is a potential overpayment to claims. Codes included:80503, 80504, 80505, 80506, ,81599, 83020, 84165, 84166, 85576, 85390, 86255, 86320, 86325, 86334, 86335,88104, 88106, 88108, 88112, 88120, 88121, 88125, 88141, 88160, 88161, 88162, 88172, 88173, 88177, 88199, 88300, 88302, 88304, 88305, 88307, 88309, 88311, 88312, 88313, 88314, 88319, 88321, 88323, 88325, 88329, 88331, 88332, 88333, 88334, 88346, 88348, 88350, 88362, 88363, 88375, 88380, 88381, 88387, 88388, 88399, 89240, G0416, G0452 MyCare 5/1/2026 20-Physician/Osteopath, Individual 6/2/20266/3/20266/1/20265/27/2026 Target Claims reprocessing date 6/30/26-7/7/2026 In Process Confidential and Proprietary Unique ID and Description of CPSELine of BusinessDate CPSE was First IdentifiedBilling Provider Type(s) Impacted by CPSE (select all that apply)Timeline for Fixing CPSEDate(s) and/or Date Span(s) of Corrected Claims Adjustments CPSE StatusUnique ID CSO0710826:Confirmed CPSEBehavioral Health claims billed with place of service 2 and 10 denied 4SW (Disallow Verify place of service) when crossed over to Medicaid and should pay. This is a potential underpayment to claims. MyCare5/11/202620-Physician/Osteopath, Individual24-Physician Assistant37-Licensed Independent Social Worker (LISW)42-Psychologist, Individual47-Professional Clinical Counselor54-Licensed Independent Chemical DependencyCounselor72-Nurse Practitioner, Individual 5/13/2026 5/14/20265/19/2026Target Claim reprocessing date 6/29/26-7/6/2026In ProcessUnique ID CSO0729158:Confirmed CPSECorrected claims that denied for timely filing recovered previous payment from the original claim and should not have. This is a potential underpayment to claims. Medicaid 5/15/2026 00-All provider types6/2/2026 Target Claims reprocessing date 6/30/2026-7/6/2026 In ProcessUnique ID CSO0722311:Confirmed CPSE Professional claims billed with procedure code T1001 (Nursing assessment/evaluation) by two different providers within a 60 day period denied 181 (Disallow exceeds maximum number of units) and should pay. This is a potential underpayment to claims. Medicaid & MyCare 5/15/2026 16 & 60-Home Health Agency6/11/2026 Target Claims reprocessing date 7/9/2026-7/16/2026 In ProcessUnique ID TFS1742869:Confirmed CPSEProfessional claims billed with procedure codes (see below) and a GT modifier denied p08 (Required modifier is missing or invalid) and should pay. This is a potential underpayment to claims.Codes included:97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T Medicaid & MyCare 5/15/2026 53-Behavior Analyst 5/18/2026 Target Claims reprocessing date 7/2/2026-7/9/2026 In ProcessUnique ID CSO0722714:Confirmed CPSEProfessional claims billed with procedure codes (see below) denied X99 (Not a covered service/procedure) and should pay. This is a potential underpayment to claims. Codes included:90662, 98966, 98967, 98968, 99070, 99173, 99291, 99292, 99408, G0008, G0179, G0180, G0404, G0426, G0427, L3935, S5136 Medicaid & MyCare 5/18/202620-Physician/Osteopath, Individual24-Physician Assistant 6/29/2026Target Claims reprocessing date 7/25/2026-8/2/2026In ProcessUnique ID CSO0761306:Confirmed CPSEProfessional claims billed with procedure codes 90791 (Psychiatric diagnostic evaluation) and 90792 (Psychiatric diagnostic evaluation with medical services) denied Z50 (Medicare Non-Covered Service) and should pay. This is a potential underpayment to claims. MyCare5/28/202620-Physician/Osteopath, Individual37-Licensed Independent Social Worker (LISW)42-Psychologist, Individual47-Professional Clinical Counselor52-Independent Marriage and Family Therapist54-Licensed Independent Chemical DependencyCounselor72-Nurse Practitioner, Individual 7/8/2026 Target Claims reprocessing date 8/5/2026-8/12/2026In ProcessUnique ID CSO0752974:Confirmed CPSEBehavioral health claims billed with diagnosis (see below) denied 41R (Disallow Invalid ICD9/10-CM diagnosis) and should pay. This is a potential underpayment to claims. Codes included:F50010, F50011, F50019, F50020, F50021, F5022, F50811, F50812, F5089 Medicaid & MyCare 5/29/202620-Physician/Osteopath, Individual24-Physician Assistant37-Licensed Independent Social Worker (LISW)96-Paraprofessional47-Professional Clinical Counselor72-Nurse Practitioner, Individual 7/9/2026 Target Claims reprocessing date 8/21/2026-8/28/2026In ProcessUnique ID CSO0759797:Confirmed CPSEProfessional claims billed with procedure codes (see below) for Out of Network providers with place of service 31, 32 and 33 paid and should deny PA required-non par provider. This is a potential overpayment to claims. Codes included:36415, 70110, 70140, 70150, 70360, 71045, 71046, 71100, 71101, 71110, 72020, 72040, 72050, 72070, 72083, 72100, 72120, 72170, 72220, 73000, 73020, 73030, 73060, 73070, 73080, 73090, 73100, 73110, 73120, 73130, 73140, 73502, 73503, 73521, 73522, 73551, 73552, 73560, 73562, 73564, 73590, 73600, 73610, 73620, 73630, 73660, 74018, 74019, 76514, 76536, 76604, 76642, 76700, 76705, 76770, 76775, 76856, 76857, 76870, 76882, 93000, 93005, 93010, 93306, 93308, 93880, 93922, 93925, 93926, 93970, 93971, 93975, P9603, P9604, Q0092, R0070, R0075 Medicaid & MyCare 6/1/2026 20-Physician/Osteopath, Individual24-Physician Assistant80-Independent Laboratory 7/23/2026 Target Claims reprocessing date 8/20/2026-8/27/2026In ProcessUnique ID CSO0761191:Confirmed CPSEProfessional claims billed with procedure code 92273 "Electroretinography (ERG), with interpretation and report; full field (ie, ffERG, flash ERG, Ganzfeld ERG)" denied Z50 (Medicare Non-Covered Service) and should pay. This is a potential underpayment to claims. MyCare6/4/2026 35-Optometrist, Individual 7/24/2026 Target Claims reprocessing date 8/21/2026-8/28/2026 In Process Confidential and ProprietaryOH-Multi-P-5697451
Pharmacy Policy Updates June 2026The following policies are effective July 1, 2026CareSource Dual Advantage (HMO D-SNP) CareSource Dual Advantage Plus (HMO D-SNP) 2 Y0119_GA-SNP-P -5691354_C | Policy Updates Network Notification | June 2026AT CARESOURCE, WE LISTEN TO OUR PROVIDERS, AND WE STREAMLINE OUR BUSINESS PRACTICES TO MAKE IT EASIER FOR YOU TO WORK WITH US. We have worked to create a predictable cycle for releasing administrative, pharmacy, and reimbursement policies, so you know wha t to expect.Check back each month for a consolidated network notification of policy updates from CareSource.HOW TO USE THIS NETWORK NOTIFICATION Reference the list of policy updates. Note the effective date and impacted plans for each policy. Click the hyperlinked policy title to open the webpage containing the policy location. FIND OUR POLICIES ONLINETo access all CareSource policies, visit CareSource.com Providers Tools & Resources Provider Policies . Select your plan and state, then Pharmacy, Reimbursement, or Administrative. Each policy page has an archive where you can find previous versions of poli cies. PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACT Kisunla (donanemab-azbt intravenous infusion Lilly)JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Leqembi ( lecanemab-irmb intravenous infusion Eisai/Biogen)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Bildyos (denosumab-nxxp subcutaneousinjection Organon)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Bosaya (denosumab-kyqq subcutaneousinjection Biocon)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Conexxence (denosumab-bnht subcutaneous injection Fresenius Kabi) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION3 Y0119_GA-SNP-P -5691354_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACT Enoby (denosumab-qbde subcutaneousinjection Hikma)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Jubbonti (denosumab-bbdz subcutaneousinjection Sandoz)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Ospomyv (denosumab-dssb subcutaneous injection Samsung Bioepis ) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Prolia (denosumab subcutaneous injection Amgen JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Stoboclo (denosumab-bmwo subcutaneous injection Celltrion) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION4 Y0119_GA-SNP-P -5691354_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACT Evenity (romosozumab- aqqg subcutaneous injection Amgen) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Ibandronate intravenous infusion generic JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Reclast (zoledronic acid intravenous infusion Novartis, generic)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Tzield (teplizumab-mzwv intravenous infusion Provention/Sanofi) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Actemra (tocilizumab intravenous infusion Genentech/Roche) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION5 Y0119_GA-SNP-P -5691354_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACT Avtozma (tocilizumab- anoh intravenous infusion Celltrion) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Tofidence (tocilizumab-bavi intravenous infusion Biogen) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Tyenne (tocilizumab-aazg intravenous infusion Fresenius Kabi)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Spevigo (spesolimab-sbzo intravenous infusion Boehringer Ingelheim) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Orencia (abatacept intravenous infusion Bristol-Myers Squibb) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION6 Y0119_GA-SNP-P -5691354_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACT Fasenra (benralizumab subcutaneous injection AstraZeneca) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Waskyra (etuvetidigene autotemcel intravenous infusion Fondazione Telethon ETS) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) NEW Supprelin LA (histrelin acetate subcutaneous implant Endo) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Zoladex (goserelin acetate subcutaneous implant TerSera Therapeutics) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Vpriv (velaglucerase intravenous infusion Takeda) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION7 Y0119_GA-SNP-P -5691354_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACT Elelyso ( taliglucerase intravenous infusion Pfizer) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Elaprase ( idursulfase intravenous infusion Takeda) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Kyprolis (carfilzomib intravenous infusion Amgen/Onyx) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Tecentriq (atezolizumab intravenous infusion Genentech/Roche) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Tecentriq Hybreza (atezolizumab and hyaluronidase-tqjs subcutaneous injection Genentech) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION8 Y0119_GA-SNP-P -5691354_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACT Opdivo (nivolumab intravenous infusion Bristol-Myers Squibb) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Rybrevant ( amivantamab-vmjw intravenous infusion Janssen) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Imjudo ( tremelimumab-actl intravenous infusion AstraZeneca)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Kebilidi (eladocagene exuparvovec-tneq suspension for intraputaminal infusion PTC Therapeutics) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Stelara (ustekinumab intravenous infusion Janssen Biotech) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION9 Y0119_GA-SNP-P -5691354_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACTImuldosa (ustekinumab-srlf intravenous infusion Accord) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Otulfi (ustekinumab-aauz intravenous infusion Formycon/Fresenius)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Pyzchiva (ustekinumab-ttwe intravenous infusion Sandoz/Samsung) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Selarsdi (ustekinumab-aekn intravenous infusion Alvotech/Teva)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Starjemza (ustekinumab-hmny intravenous infusion BioThera ) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION10 Y0119_GA-SNP-P -5691354_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACTSteqeyma (ustekinumab-stba intravenous infusion Celltrion) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Wezlana (ustekinumab-auub intravenous infusion Amgen) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Yesintek (ustekinumab-kfce intravenous infusion Biocon) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Ustekinumab intravenous infusion (Janssen Biotech) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Ustekinumab-ttwe intravenous infusion ( Quallent ) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION11 Y0119_GA-SNP-P -5691354_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACTImcivree (setmelanotide subcutaneous injection Rhythm) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Empliciti ( elotuzumab intravenous infusion Bristol-Myers Squibb) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Imlygic ( talimogene laherparepvec intralesional injection Amgen/ BioVex ) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Adstiladrin (nadofaragene firadenovec-vncg intravesical suspension Ferring) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Anktiva (nogapendekin alfa inbakicept-pmln intravesical solution ImmunityBio) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION12 Y0119_GA-SNP-P -5691354_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACT Encelto ( revakinagene taroretcel-lwey intravitreal implant Neurotech) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Otarmeni ( lunsotogene parvec-cwha intracochlear infusion Regeneron) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Vabysmo ( faricimab-svoa intravitreal injection Genentech)JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISIONAvlayah ( tividenofusp alfa-eknm intravenous infusion Denali) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) NEW Oncology (Injectable-CD38-Directed Cytolytic Antibody) – Sarclisa UM Medical Policy JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) NEW13 Y0119_GA-SNP-P -5691354_C | Policy Updates Network Notification | June 2026
Pharmacy Policy Updates June 2026The following policies are effective July 1, 2026HAP CareSource MI Coordinated Health (HMO D-SNP) 2 Policy Updates Network Notification | H4193_MI-SNP-P -5691452_C | June 2026AT HAP CARESOURCE, WE LISTEN TO OUR PROVIDERS, AND WE STREAMLINE OUR BUSINESS PRACTICES TO MAKE IT EASIER FOR YOU TO WORK WITH US. We have worked to create a predictable cycle for releasing administrative, pharmacy, and reimbursement policies, so you know wha t to expect.Check back each month for a consolidated network notification of policy updates from HAP CareSource.HOW TO USE THIS NETWORK NOTIFICATION Reference the list of policy updates. Note the effective date and impacted plans for each policy. Click the hyperlinked policy title to open the webpage containing the policy location. FIND OUR POLICIES ONLINETo access all HAP CareSource policies, visit HAPCareSource.com > Providers > Tools & Resources > Provider Policies . Select your plan and state, then Pharmacy, Reimbursement, or Administrative. Each policy page has an archive where you can find previous versions of policies. PHARMACY POLICY UPDATES3 Policy Updates Network Notification | H4193_MI-SNP-P -5691452_C | June 2026 POLICY NAME EFFECTIVE DATE PLAN IMPACT Kisunla (donanemab-azbt intravenous infusion Lilly)JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Leqembi ( lecanemab-irmb intravenous infusion Eisai/Biogen)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Bildyos (denosumab-nxxp subcutaneousinjection Organon)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Bosaya (denosumab-kyqq subcutaneousinjection Biocon)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Conexxence (denosumab-bnht subcutaneous injection Fresenius Kabi) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION PHARMACY POLICY UPDATES4 Policy Updates Network Notification | H4193_MI-SNP-P -5691452_C | June 2026 POLICY NAME EFFECTIVE DATE PLAN IMPACT Enoby (denosumab-qbde subcutaneousinjection Hikma)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Jubbonti (denosumab-bbdz subcutaneousinjection Sandoz)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Ospomyv (denosumab-dssb subcutaneous injection Samsung Bioepis ) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Prolia (denosumab subcutaneous injection Amgen JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Stoboclo (denosumab-bmwo subcutaneous injection Celltrion) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION PHARMACY POLICY UPDATES5 Policy Updates Network Notification | H4193_MI-SNP-P -5691452_C | June 2026 POLICY NAME EFFECTIVE DATE PLAN IMPACT Evenity (romosozumab- aqqg subcutaneous injection Amgen) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Ibandronate intravenous infusion generic JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Reclast (zoledronic acid intravenous infusion Novartis, generic)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Tzield (teplizumab-mzwv intravenous infusion Provention/Sanofi) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Actemra (tocilizumab intravenous infusion Genentech/Roche) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION PHARMACY POLICY UPDATES6 Policy Updates Network Notification | H4193_MI-SNP-P -5691452_C | June 2026 POLICY NAME EFFECTIVE DATE PLAN IMPACT Avtozma (tocilizumab- anoh intravenous infusion Celltrion) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Tofidence (tocilizumab-bavi intravenous infusion Biogen) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Tyenne (tocilizumab-aazg intravenous infusion Fresenius Kabi)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Spevigo (spesolimab-sbzo intravenous infusion Boehringer Ingelheim) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Orencia (abatacept intravenous infusion Bristol-Myers Squibb) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION PHARMACY POLICY UPDATES7 Policy Updates Network Notification | H4193_MI-SNP-P -5691452_C | June 2026 POLICY NAME EFFECTIVE DATE PLAN IMPACT Fasenra (benralizumab subcutaneous injection AstraZeneca) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Waskyra (etuvetidigene autotemcel intravenous infusion Fondazione Telethon ETS) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) NEW Supprelin LA (histrelin acetate subcutaneous implant Endo) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Zoladex (goserelin acetate subcutaneous implant TerSera Therapeutics) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Vpriv (velaglucerase intravenous infusion Takeda) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION PHARMACY POLICY UPDATES8 Policy Updates Network Notification | H4193_MI-SNP-P -5691452_C | June 2026 POLICY NAME EFFECTIVE DATE PLAN IMPACT Elelyso ( taliglucerase intravenous infusion Pfizer) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Elaprase ( idursulfase intravenous infusion Takeda) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Kyprolis (carfilzomib intravenous infusion Amgen/Onyx) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Tecentriq (atezolizumab intravenous infusion Genentech/Roche) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Tecentriq Hybreza (atezolizumab and hyaluronidase-tqjs subcutaneous injection Genentech) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION PHARMACY POLICY UPDATES9 Policy Updates Network Notification | H4193_MI-SNP-P -5691452_C | June 2026 POLICY NAME EFFECTIVE DATE PLAN IMPACT Opdivo (nivolumab intravenous infusion Bristol-Myers Squibb) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Rybrevant ( amivantamab-vmjw intravenous infusion Janssen) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Imjudo ( tremelimumab-actl intravenous infusion AstraZeneca)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Kebilidi (eladocagene exuparvovec-tneq suspension for intraputaminal infusion PTC Therapeutics) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Stelara (ustekinumab intravenous infusion Janssen Biotech) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION PHARMACY POLICY UPDATES10 Policy Updates Network Notification | H4193_MI-SNP-P -5691452_C | June 2026 POLICY NAME EFFECTIVE DATE PLAN IMPACTImuldosa (ustekinumab-srlf intravenous infusion Accord) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Otulfi (ustekinumab-aauz intravenous infusion Formycon/Fresenius)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Pyzchiva (ustekinumab-ttwe intravenous infusion Sandoz/Samsung) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Selarsdi (ustekinumab-aekn intravenous infusion Alvotech/Teva)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Starjemza (ustekinumab-hmny intravenous infusion BioThera ) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION PHARMACY POLICY UPDATES11 Policy Updates Network Notification | H4193_MI-SNP-P -5691452_C | June 2026 POLICY NAME EFFECTIVE DATE PLAN IMPACTSteqeyma (ustekinumab-stba intravenous infusion Celltrion) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Wezlana (ustekinumab-auub intravenous infusion Amgen) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Yesintek (ustekinumab-kfce intravenous infusion Biocon) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Ustekinumab intravenous infusion (Janssen Biotech) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Ustekinumab-ttwe intravenous infusion ( Quallent ) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION PHARMACY POLICY UPDATES12 Policy Updates Network Notification | H4193_MI-SNP-P -5691452_C | June 2026 POLICY NAME EFFECTIVE DATE PLAN IMPACTImcivree (setmelanotide subcutaneous injection Rhythm) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Empliciti ( elotuzumab intravenous infusion Bristol-Myers Squibb) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Imlygic ( talimogene laherparepvec intralesional injection Amgen/ BioVex ) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Adstiladrin (nadofaragene firadenovec-vncg intravesical suspension Ferring) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Anktiva (nogapendekin alfa inbakicept-pmln intravesical solution ImmunityBio) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION PHARMACY POLICY UPDATES13 Policy Updates Network Notification | H4193_MI-SNP-P -5691452_C | June 2026 POLICY NAME EFFECTIVE DATE PLAN IMPACT Encelto ( revakinagene taroretcel-lwey intravitreal implant Neurotech) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Otarmeni ( lunsotogene parvec-cwha intracochlear infusion Regeneron) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Vabysmo ( faricimab-svoa intravitreal injection Genentech)JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISIONAvlayah ( tividenofusp alfa-eknm intravenous infusion Denali) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) NEW Oncology (Injectable-CD38-Directed Cytolytic Antibody) – Sarclisa UM Medical Policy JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) NEW
Pharmacy Policy Updates June 2026The following policies are effective July 1, 2026CareSource MyCare Ohio (Medicare-Medicaid Plan) 2 H6396_OH-SNP-P -5691550_C | Policy Updates Network Notification | June 2026AT CARESOURCE, WE LISTEN TO OUR PROVIDERS, AND WE STREAMLINE OUR BUSINESS PRACTICES TO MAKE IT EASIER FOR YOU TO WORK WITH US. We have worked to create a predictable cycle for releasing administrative, pharmacy, and reimbursement policies, so you know wha t to expect.Check back each month for a consolidated network notification of policy updates from CareSource.HOW TO USE THIS NETWORK NOTIFICATION Reference the list of policy updates. Note the effective date and impacted plans for each policy. Click the hyperlinked policy title to open the webpage containing the policy location. FIND OUR POLICIES ONLINETo access all CareSource policies, visit CareSource.com Providers Tools & Resources Provider Policies . Select your plan and state, then Pharmacy, Reimbursement, or Administrative. Each policy page has an archive where you can find previous versions of poli cies. PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACT Kisunla (donanemab-azbt intravenous infusion Lilly)JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Leqembi ( lecanemab-irmb intravenous infusion Eisai/Biogen)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Bildyos (denosumab-nxxp subcutaneousinjection Organon)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Bosaya (denosumab-kyqq subcutaneousinjection Biocon)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Conexxence (denosumab-bnht subcutaneous injection Fresenius Kabi) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION3 H6396_OH-SNP-P -5691550_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACT Enoby (denosumab-qbde subcutaneousinjection Hikma)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Jubbonti (denosumab-bbdz subcutaneousinjection Sandoz)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Ospomyv (denosumab-dssb subcutaneous injection Samsung Bioepis ) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Prolia (denosumab subcutaneous injection Amgen JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Stoboclo (denosumab-bmwo subcutaneous injection Celltrion) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION4 H6396_OH-SNP-P -5691550_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACT Evenity (romosozumab- aqqg subcutaneous injection Amgen) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Ibandronate intravenous infusion generic JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Reclast (zoledronic acid intravenous infusion Novartis, generic)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Tzield (teplizumab-mzwv intravenous infusion Provention/Sanofi) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Actemra (tocilizumab intravenous infusion Genentech/Roche) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION5 H6396_OH-SNP-P -5691550_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACT Avtozma (tocilizumab- anoh intravenous infusion Celltrion) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Tofidence (tocilizumab-bavi intravenous infusion Biogen) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Tyenne (tocilizumab-aazg intravenous infusion Fresenius Kabi)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Spevigo (spesolimab-sbzo intravenous infusion Boehringer Ingelheim) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Orencia (abatacept intravenous infusion Bristol-Myers Squibb) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION6 H6396_OH-SNP-P -5691550_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACT Fasenra (benralizumab subcutaneous injection AstraZeneca) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Waskyra (etuvetidigene autotemcel intravenous infusion Fondazione Telethon ETS) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) NEW Supprelin LA (histrelin acetate subcutaneous implant Endo) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Zoladex (goserelin acetate subcutaneous implant TerSera Therapeutics) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Vpriv (velaglucerase intravenous infusion Takeda) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION7 H6396_OH-SNP-P -5691550_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACT Elelyso ( taliglucerase intravenous infusion Pfizer) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Elaprase ( idursulfase intravenous infusion Takeda) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Kyprolis (carfilzomib intravenous infusion Amgen/Onyx) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Tecentriq (atezolizumab intravenous infusion Genentech/Roche) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Tecentriq Hybreza (atezolizumab and hyaluronidase-tqjs subcutaneous injection Genentech) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION8 H6396_OH-SNP-P -5691550_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACT Opdivo (nivolumab intravenous infusion Bristol-Myers Squibb) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Rybrevant ( amivantamab-vmjw intravenous infusion Janssen) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Imjudo ( tremelimumab-actl intravenous infusion AstraZeneca)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Kebilidi (eladocagene exuparvovec-tneq suspension for intraputaminal infusion PTC Therapeutics) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Stelara (ustekinumab intravenous infusion Janssen Biotech) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION9 H6396_OH-SNP-P -5691550_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACTImuldosa (ustekinumab-srlf intravenous infusion Accord) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Otulfi (ustekinumab-aauz intravenous infusion Formycon/Fresenius)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Pyzchiva (ustekinumab-ttwe intravenous infusion Sandoz/Samsung) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Selarsdi (ustekinumab-aekn intravenous infusion Alvotech/Teva)JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Starjemza (ustekinumab-hmny intravenous infusion BioThera ) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION10 H6396_OH-SNP-P -5691550_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACTSteqeyma (ustekinumab-stba intravenous infusion Celltrion) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Wezlana (ustekinumab-auub intravenous infusion Amgen) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Yesintek (ustekinumab-kfce intravenous infusion Biocon) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Ustekinumab intravenous infusion (Janssen Biotech) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Ustekinumab-ttwe intravenous infusion ( Quallent ) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION11 H6396_OH-SNP-P -5691550_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACTImcivree (setmelanotide subcutaneous injection Rhythm) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Empliciti ( elotuzumab intravenous infusion Bristol-Myers Squibb) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Imlygic ( talimogene laherparepvec intralesional injection Amgen/ BioVex ) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Adstiladrin (nadofaragene firadenovec-vncg intravesical suspension Ferring) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Anktiva (nogapendekin alfa inbakicept-pmln intravesical solution ImmunityBio) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION12 H6396_OH-SNP-P -5691550_C | Policy Updates Network Notification | June 2026 PHARMACY POLICY UPDATES POLICY NAMEEFFECTIVE DATE PLAN IMPACT Encelto ( revakinagene taroretcel-lwey intravitreal implant Neurotech) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Otarmeni ( lunsotogene parvec-cwha intracochlear infusion Regeneron) JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISION Vabysmo ( faricimab-svoa intravitreal injection Genentech)JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) REVISIONAvlayah ( tividenofusp alfa-eknm intravenous infusion Denali) JULY 1, 2026CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) NEW Oncology (Injectable-CD38-Directed Cytolytic Antibody) – Sarclisa UM Medical Policy JULY 1, 2026 CARESOURCE MYCARE OHIO (MEDICARE-MEDICAID PLAN) HAP CARESOURCE MI COORDINATED HEALTH (HMO D-SNP) CARESOURCE DUAL ADVANTAGE (HMO D-SNP) CARESOURCE DUAL ADVANTAGE PLUS (HMO D-SNP) NEW13 H6396_OH-SNP-P -5691550_C | Policy Updates Network Notification | June 2026
Administrative Policy Statement MARKETPLACE PLANS Policy Name Policy Number Date Effective Medical Benefit Medications PAD-0013-MPP 07/01/2026 Policy Type Medical ADMINISTRATIVE Pharmacy Reimbursement Administrative Policy Statement s prepared by CSMG Co. and its affiliates (including CareSource) are derived from literature based on and supported by clinical guidelines, nationally recognized utilization and technology assessment guidelines, other medical management industry standards, and published MCO clinical policy guidelines. Medically necessary services include, but are not limited to, those health care services or supplies that are proper and necessary for the diagnosis or treatment of disease, illness, or injury and without which the patient can be expected to suffer prolonged, increased or new morbidity, impairment of function, dysfunction of a body organ or part, or significant pain and discomfort. These services meet the standards of good medical practice in the local area, are the lowest cost alternative, and are not provided mainly for the convenience of the member or provider. Medically necessary services also include those services defined in any Evidence of Coverage documents, Medical Policy Statements, Provider Manuals, Member Handbooks, and/or other policies and procedures. Administrative Policy Statements prepared by CSMG Co. and its affiliates (including CareSource) do not ensure an authorization or payment of services. Please refer to the plan contract (often referred to as the Evidence of Coverage) for the service(s) referenced in the Administrative Policy Statement. If there is a conflict between the Administrative Policy Statement and the plan contract (i.e., Evidence of Coverage), then the plan contract (i.e., Evidence of Coverage) will be the controlling document used to make the determination. Table of Contents A. SUBJECT ………………………………………………………………………………………………………….. 2 B. BACKGROUND …………………………………………………………………………………………………. 2 C. DEFINITIONS ……………………………………………………………………………………………………. 2 D. POLICY …………………………………………………………………………………………………………….. 3 E. CONDITIONS OF COVERAGE ……………………………………………………………………………. 4 F. RELATED POLICIES/RULES ………………………………………………………………………………. 4 G. REVIEW/REVISION HISTORY …………………………………………………………………………….. 4 Medical Benefit Medications Marketplace Plans PAD-0013-MPP Effective date: 07/01/20262 A. SUBJECT CareSource uses Pharmacy Policy Statements to determine coverage for medications that are covered under the medical benefit, as determined by the CareSource Pharmacy and Therapeutics (P&T) Committee. Pharmacy Policy Statements contain criteria designed to ensure that CareSource members safely receive effective medication. Some medical benefit medications may not be addressed by a specific Pharmacy Policy Statement. In that case, the reviewing pharmacists will make a clinical determination based on the information outlined here. B. BACKGROUND The intent of CareSource Policy Statements is to encourage appropriate selection of drug therapy for members according to product labeling, clinical guidelines, and/or clinical studies as well as to encourage use of Marketplace preferred drugs. The CareSource Policy Statement is a guideline for determining health care coverage for our members with benefit plans covering prescription drugs. Pharmacy Policy Statements are written on selected prescription drugs requiring prior authorization or step therapy. The Pharmacy Policy Statement is used as a tool to be interpreted in conjunction with the members specific benefit plan. Note: The Introduction section is for your general knowledge and is not to be construed as policy coverage criteria. The rest of the policy uses specific words and concepts familiar to medical professionals and is intended for providers. A provider can be a pers on, such as a doctor, nurse, psychologist, or dentist. A provider can also be a place where medical care is given, like a hospital, clinic, or lab. This policy informs providers about when a product or service may be covered. C. DEFINITIONS Administrative Review/Approval/Denial: a decision for coverage or non-coverage of a drug which is made regarding the organization and delivery of the drugs according to a members benefits, policies & procedures, and/or legislature & regulation which do not require clinical expertise or subject knowledge. Clinical Judgement: decisions made within the scope and expertise of a pharmacist following the review of subjective and objective medical data for a member. A pharmacist can use Clinical Judgement for the benefit determination for an exceptions request for a Medical Benefit Drug. If the request is outside the scope of a pharmacists expertise, a benefit determination will be made in collaboration with a medical director. Drug: a medication or substance which induces a physiologic effect on the body of a member (i.e., medication, agent, drug therapy, treatment, product, biosimilar drug, etc.) . Medical Benefit Drug: a drug that is usually administered by a healthcare provider or in a supervised healthcare setting and is billed to CareSource through the medical benefit and is subject to the appropriate member cost share based on the Schedule of Benefits (SOB) and/or Summary of Benefits and Coverage (SBC) . Medical Benefit Medications Marketplace Plans PAD-0013-MPP Effective date: 07/01/20263 Non-Preferred Drug: a drug that has been determined by CareSource to be less clinically efficacious or cost-effective for an FDA-approved use than other available drugs by the CareSource P&T Committee. Preferred Drug: the drug of choice for CareSource for an FDA-approved use as indicated on a Pharmacy Policy Statement available on the CareSource website and based on clinical efficacy and cost as determined by the CareSource P&T Committee. Specialty Drug: a drug which treats highly complex diseases and/or requires special handling or distribution and is usually high cost. Many of these drugs require prior authorization and may be dispensed at limited locations. Please see CareSources Specialty Drug List on the CareSource website. D. POLICY I. Medical Benefit Drugs may require review and approval by a pharmacist and/or medical director before being approved for payment. This policy will not supersede drug-specific clinical criteria developed and approved by the CareSource P&T Committee. When CareSource approves coverage of a Medical Benefit Drug it will be considered Medically Necessary when ALL of the following criteria have been met: A. Prior Authorization requests should be submitted for each Medical Benefit Drug with chart notes and member-specific documentation AND B. The members indication, dose, and duration for the use of the requested Medical Benefit Drug is approved by the Food & Drug Administration (FDA) or an indication supported in the compendia or current peer-reviewed literature or evidence-based guidelines A ND C. One of the following is true: 1. The Medical Benefit Drug is a Preferred Drug by CareSource OR 2. The member is unable to take the Preferred Drug(s) because: a. The member has a clinical condition for which there is no Marketplace Preferred Drug and/or needed dosage form suitable to treat the members diagnosis OR b. The Marketplace Preferred Drug(s) is/are not recommended based on published guidelines or clinical literature OR c. The Marketplace Preferred Drug(s) is/are expected to be ineffective or less effective for the member based on submitted documentation and medical history OR d. The Marketplace Preferred Drug(s) is/are expected to cause an adverse effect based on submitted documentation and medical history. II. For all Medical Benefit Drugs, including those that have drug-specific clinical criteria: A. If requested agent is a Medical Benefit Drug with a self-administered dosage form available, documentation of the rationale that the member is unable to utilize the self-administered version must be included. Self-administered drugs are generally not covered under the medical benefit. B. Documentation that the drug being requested is planned to be administered in the appropriate site of care. Medical Benefit Medications Marketplace Plans PAD-00 13-MPP Effective date: 07/01/20264 III. For Reauthorization: A. Documentation has been provided showing the member has had a positive response to therapy; AND B. Documentation has been provided showing the member is compliant with therapy; AND C. The requested use and dosage remain consistent with FDA-approved prescribing information in the drug package insert. E. CONDITIONS OF COVERAGE HCPCS CPT A UTHORIZATION PERIOD : as determined by the approving pharmacists Clinical Judgement F. RELATED POLICIES/RULES Non-Formulary Medications Policy Off Label Medication Requests Policy Drug-specific policies posted on the CareSource website may apply G. REVIEW/REVISION HISTORY DATE S ACTIONDate Issued 11/07/2019 Drafted policy language; updated references to SOB and SBCDate Revised 11/17/2021 Annual review, no changes. 12/19/2022 Annual review, no changes.6/6/2023 Removed Medical Necessity and updated related policies and rules to align with new policy titles.5/21/24 Annual review, no changes5/22/2025 Added reauthorization criteria2/17/2026 Annual review, no changes.4/7/2026 Added criteria regarding self-administered drugs and site of care. Date Effective 10/01/2025 Date Archived H. REFERENCES1. Definitions for Administrative Review or Clinical Judgement: Ombudsman Saskatchewan, Canada; Administrative versus Clinical Decisions January 2016. 2. 45 CFR Chapter A Subchapter B-156.122 Prescription drug benefits. 3. 2026 NCQA Standards and Guidelines for the Accreditation of Health Plans.
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