Effective Jan. 1, 2021, for UnitedHealthcare Medicare Advantage, UnitedHealthcare Community Plan and commercial members, will require prior authorization and notification for Tecartus or related services, including outpatient or inpatient evaluation and the CAR-T outpatient or inpatient episode. Coverage reviews for Tecartus will be managed by Optum Transplant Resource Services through the same process as other CAR-T therapies. Care providers must contract with Optum Transplant Resource Services to receive prior authorization and bill for CAR-T therapy. Pre-determination reviews for Tecartus prior to this requirement are encouraged and can be requested by contacting Optum Transplant Resource Services at the number below.
As with all prior authorization and notification requirements, if you provide any CAR-T services without first completing the prior authorization and notification requirements process, the claim may be denied. Members can’t be billed for services denied due to failure to complete the notification/prior authorization process.
Questions? Contact Optum Transplant Resources Services at 888-936-7246.
Coverage of these products is dependent on State Medicaid program decisions. Certain state Medicaid programs may choose to cover a drug through the state’s fee-for-service program and not the managed care organizations such as UnitedHealthcare, or they may provide other coverage guidelines and protocols. We encourage you to verify benefits before submitting the prior authorization request or administering the medication.