September 01, 2024
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:
| Drug name | HCPCS code (s) |
|---|---|
| Abecma® (idecabtagene vicleucel) | Q2055 |
| Acthar® Gel (repository corticotropin injection) | J0801 |
| Adzynma™ (ADAMTS13, recombinant-krhn) | J7171 |
| Amondys 45® (casimersen) | J1426 |
| Breyanzi® (lisocabtagene maraleucel) | Q2054 |
| Carvykti™ (ciltacabtagene autoleucel) | Q2056 |
| Cortrophin® Gel (repository corticotropin injection) | J0802 |
| Cosentyx® IV (secukinumab) | J3247 |
| Elevidys™ (delandistrogene moxeparvovec-rokl) | J1413 |
| Elfabrio® (pegunigalsidase alfa-iwxj) | J2508 |
| Evkeeza® (evinacumab-dgnb) | J1305 |
| Eylea® HD (aflibercept) | J0177 |
| Hemgenix™ (etranacogene dezaparvovec-drlb) | J1411 |
| Lamzede® (velmanase alfa-tycv) | J0217 |
| Omvoh™ (mirikizumab-mrkz) | J2267 |
| Pombiliti™ (cipaglucosidase alfa-atga) | J1203 |
| Qalsody™ (tofersen) | J1304 |
| Roctavian™ (valoctogcogene roxaparvovec-rvox) | J1412 |
| Rystiggo™ (rozanolixizumab-noli) | J9333 |
| Tecartus® (brexucabtagene autoleucel) | Q2053 |
| Veopoz™ (pozelimab-bbfg) | J9376 |
| Vyjuvek™ (beremagene geperpavec-svdt) | J3401 |
| Vyvgart® (efgartigimod alfa-fcab) | J9332 |
| Vyvgart® Hytrulo™ (efgartigimd alfa and hyaluronidase-qvfc) | J9334 |
| Zynteglo™ (betibeglogene autotemcel) | J3393 |
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.
Questions? We're here to help.
Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal. For additional contact information, visit our Contact us page.
PCA-1-24-02542-Clinical-NN_08162024
