Rocky Mountain Health Plans: Prior authorization updates starting May 1, 2024
Affects some physician-administered medications in outpatient settings
Starting May 1, 2024, we will require prior authorization for the following newly added medications.
For Monument One, Colorado Doctors Plan, Rocky Mountain Valley Health Plan, Rocky Mountain Sky Plan, Sky Colorado Option and Monument Health plans:
| Medication | HCPCS code |
|---|---|
| Acthar® Gel (repository corticotropin injection) | J0801 |
| Asceniv™ (immune globulin intravenous [human]) | J1554 |
| Briumvi™ (ublituximab-xiiy) | J2329 |
| Purified Corticotropin™ Gel (repository corticotropin) | J0802 |
| Qalsody™ (tofersen) | J1304 |
For Rocky Mountain Health Plans Medicaid PRIME and CHP+ plans:
| Medication | HCPCS code |
|---|---|
| Aduhelm™ (aducanumab) | J0172 |
For Rocky Mountain HealthPlans CareAdvantage Value, Rocky Mountain CareAdvantage Enhanced (UnitedHealthcare© Medicare Advantage), and UnitedHealthcare Rocky Mountain Dual Complete CO-S003 (HMO-POS D-SNP) plans:
| Medication | HCPCS code |
|---|---|
| Fulphila® (pegfilgrastim-jmdb) | Q5108 |
| Qalsody™ (tofersen) | J1304 |
How to submit a prior authorization request
- Sign in to the UnitedHealthcare Provider Portal at UHCprovider.com. Click Sign In at the top-right corner to log in using your One Healthcare ID and password
- If you are a new user, go to UHCprovider.com/access to get started
- Click the Prior Authorization tab on the left side of the page and choose Specialty Pharmacy
- Enter the required information
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.
If you don’t provide sufficient clinical information, we may deny your prior authorization request. To help avoid denials, please include all documentation when submitting your prior authorization requests, according to applicable health plan protocols.
Questions?
Chat with us 7 a.m.–7 p.m. CT, Monday–Friday from the UnitedHealthcare Provider Portal. You can also call us at 888-397-8129 8 a.m.–5 p.m. local time, Monday–Friday or email us at specialtyguidanceprogram@optum.com.
PCA-1-24-00125-Clinical-NN_01162024
