Maryland Medicaid: State-required updates to specialty pharmacy prior authorization requirements

Beginning Dec. 1, 2024, we will require notification/prior authorization for the following specialty medications for UnitedHealthcare Community Plan (Medicaid) members in Maryland:

How to submit a request

You can submit a prior authorization request through the UnitedHealthcare Provider Portal:

• Go to UHCprovider.com and click Sign In at the top-right corner
• Enter your One Healthcare ID and password
  • New users who don’t have a One Healthcare ID: Visit UHCprovider.com/access to get started
• In the menu, select Prior Authorizations 
• Scroll down to “Create a new notification or prior authorization request” and click Create New Submissions
• Enter the required information and submit

Please note: For the following cell and gene therapies, you must contact Optum Transplant Services at 888-805-1802 to submit your prior authorization request: 

• Abecma
• Breyanzi
• Carvykti
• Tecartus
• Zynteglo

If we don’t receive a prior authorization request before the date of service, we’ll deny the claim and you won’t be able to balance bill members.

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