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.