Prior authorization updates for provider-administered drugs
UnitedHealthcare Community Plan of Michigan
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.
