Medicare: Changes to outpatient prior authorization process for non-oncology drugs

Effective Jan. 3, 2022, Optum, an affiliate of UnitedHealthcare, will manage prior authorization requests for non-oncology Part B medications that are covered under a UnitedHealthcare Medicare Advantage plan’s medical benefit.

This won’t change the prior authorization request process for oncology-related medications.

The new process

You’ll continue to submit your requests for Medicare Part B medications online. You can find the medications requiring prior authorization in the Medicare Advantage Prior Authorization List and in the Medicare Part B Step Therapy Program policy.

To support our review, inclusive of a timely decision, clinical requirements will be documented within the request submission. You can also attach medical records, if requested.

To submit your requests:

  • Sign in to the UnitedHealthcare Provider Portal by going to UHCprovider.com and clicking on the Sign In button in the top right corner of the page
  • Click on the Prior Authorization tool and select Specialty Pharmacy Transactions submission and status
  • This will take you to the submission site

What this means for existing authorizations

Authorizations active before  Jan. 3, 2022, will remain in effect. You’ll see the new process when you request a prior authorization starting Jan. 3, 2022.

You won’t need to submit a new request until the existing authorization expires or you change the therapy. Changes in therapy include:

  • Dose
  • Frequency of administration
  • Place of therapy

Questions?

If you can’t find what you need on UHCprovider.com, please call Optum at 888-397-8129, 8 a.m.–5 p.m. local time, Monday–Friday, for information about the new process.

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