Maryland Medicaid: New specialty medications require prior authorization
Effective Aug. 1, 2023, we will require prior authorization for the following medications listed with their HCPCS codes:
- Amvuttra® (vutrisiran) - J0225
- Enjaymo® (sutimlimab-jome) - J1302
- Releuko® (filgrastim-ayow) - Q5125
- Spevigo® (spesolimab-sbzo) - J1747
- Viltepso® (viltolarsen) - J1427
- Xenpozyme™ (olipudase alfa-rpcp) - J0218
Affected plans
This affects the following UnitedHealth benefit plans:
- UnitedHealthcare Community Plan of Maryland
How to submit a request
You can submit a prior authorization request through the UnitedHealthcare Provider Portal:
- Go to UHCprovider.com and select Sign In at the top-right corner
- Sign in to the portal using your One Healthcare ID and password
– If you are a new user and don’t have a One Healthcare ID, visit UHCprovider.com/access to get started - In the menu, select Prior Authorizations
- In the Prior Authorization and Notification tool, scroll down to “Create a new notification or prior authorization request” and click Create New Submissions
- Enter the required information and submit
Determination and review timeline
We will complete prior authorization reviews according to state-defined requirements. You’ll receive notifications of the case determination, including appeal rights, when applicable, within required time frames.
Your prior authorization requests will be denied if sufficient clinical information is not provided. Please submit all documentation when submitting your requests, according to health plan protocols.
Resources
- Training: View our Prior Authorization and Notification: Interactive User Guide
Questions? We’re here to help.
For questions about these prior authorization requirements, call us at 888-397-8129 7 a.m.–7 p.m. CT Monday–Friday.
