February 01, 2024

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 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 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.


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


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