May 01, 2022

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

Effective Aug. 1, 2022, Optum®, an affiliate of UnitedHealthcare, will manage prior authorization requests for non-oncology injectable medications that are covered on the medical benefit for UnitedHealthcare Community Plans.

This change does not apply to the following states at this time: Colorado, Indiana, Maryland, Missouri, Nevada, New York, North Carolina and Ohio.

The prior authorization request process for oncology-related medications will also remain unchanged.

The new process
You’ll continue to submit your requests for injectable medications online.

To support our review, 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
  • Enter the required information on the submission site

What this means for existing authorizations
Authorizations active before Aug. 1, 2022, will remain in effect. You’ll see the new process when you request a prior authorization starting Aug.1, 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?
View the UnitedHealthcare Community Plan Prior Authorization Requirements link on the Prior Authorization and Notification page for your specific state for a list of medications requiring prior authorization.

Call Optum at 888-397-8129, 8 a.m.–5 p.m. local time, Monday–Friday, for information about the new process or for answers to specific questions. 

PCA-22-01060-C&S-News