Prior authorization updates for provider-administered drugs

Effective for dates of service starting May 1, 2023, we will require prior authorization for the following medications and CPT® codes: 

• Enjaymo™ (sutimlimab-jome) - J1302
• Korsuva™ (difelikefalin) - J0879
• Leqvio® (inclisiran) - J1306
• Ryplazim® (plasminogen, human-tvmh) - J2998
• Tezspire® (tezepelumab-ekko) - J2356
• Vyvgart® (efgartigimod alfa-fcab) - J9332

Determination and review timeline

We’ll complete prior authorization reviews according to state-defined requirements. We’ll provide notifications of the case determination, including appeal rights when applicable, within the required time frame. 

To prevent denials due to a lack of information, please submit all clinical information when you submit a prior authorization request.

How to submit a prior authorization request

• Sign in on the UnitedHealthcare Provider Portal Resources page using your One Healthcare ID
• Click on the Prior Authorization and Notification tool
• Select Create a new notification or prior authorization request
• Enter the required information on the submission site

Please submit prior authorization requests according to the plan's protocols. You can also use the Prior Authorization and Notification tool to check requirements, submit new medical prior authorization requests and more.

Questions?

For questions related to these prior authorization requirements, call the Provider Services number on the member’s health care ID card.

For questions about prior authorizations, call 888-397-8129. Use the Prior Authorization and Notification tool to check prior authorization requirements, submit new medical prior authorizations and more. Simply, go to UHCprovider.com and sign in with your One Healthcare ID, then go to "Prior authorization" in the menu. 

CPT® is a registered trademark of the American Medical Association.

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