January 17, 2025
Louisiana Medicaid: Updates to specialty pharmacy prior authorization requirements
Beginning May 1, 2025, we’ll require prior authorization or notification for the following specialty medications for UnitedHealthcare Community Plan of Louisiana:
| Medication | HCPCS code |
|---|---|
| Amvuttra® (vutrisiran) | J0225 |
| Berinert® (C1 esterase inhibitor [human]) | J0597 |
| Cinryze® (C1 esterase inhibitor [human]) | J0598 |
| Feraheme® (ferumoxytol) | Q0138 |
| Injectafer® (ferric carboxymaltose) | J1439 |
| Kalbitor® (ecallantide) | J1290 |
| Monoferric® (ferric derisomaltose) | J1437 |
| Rituxan® (rituximab) | J9312 |
| Ruconest® (C1 esterase inhibitor [recombinant]) | J0596 |
| Ruxience® (rituximab-pvvr) | Q5119 |
| Scenesse® (afamelanotide) | J7352 |
| Stelara® (ustekinumab) | J3358 |
| Tepezza® (teprotumumab-trbw) | J3241 |
| Truxima® (rituximab-abbs) | Q5115 |
| Vyepti® (eptinezumab-jjmr) | J3032 |
Submit a prior authorization or notification
To submit prior authorization or notification, please sign in to the UnitedHealthcare Provider Portal. In the “Create a new prior authorization submission” section, select Specialty pharmacy from the dropdown.
Questions?
For questions about the prior authorization or notification process, call the Optum Specialty Guidance Program at 888-397-8129. If you have other questions, visit our Contact us page.
PCA-1-25-00071-Clinical-NN_01132025
