March 01, 2025
Updates to specialty pharmacy prior authorization requirements for UnitedHealthcare Community Plan members in Michigan
Beginning June 1, 2025, we will require prior authorization/notification for the following provider-administered medications for UnitedHealthcare Community Plan members in Michigan:
| Drug name | HCPCS code |
|---|---|
| Briumvi™ | J2329 |
| Corticotropin® Gel | J0802 |
| Daxxify® | J0589 |
| Eylea™ HD | J0177 |
| Izervay™ | J2782 |
| Leqembi™ | J0174 |
| Panzyga® | J1576 |
| Pombiliti™ | J1203 |
| Qalsody™ | J1304 |
| Rystiggo™ | J9333 |
| Syfovre™ | J2781 |
| Tofidence™ | Q5133 |
| Tzield™ | J9381 |
| Veopoz™ | J9376 |
| Vyjuvek™ | J3401 |
| Vyvgart® Hytrulo™ | J9334 |
How to submit a prior authorization and notification request
- Go to uhcprovider.com and click Sign In, located at the top of the page
- Select Prior Authorizations from the top menu bar
- Scroll down to the “Create a new prior authorization submission” section and select Specialty pharmacy from the dropdown menu
Questions?
For questions about the prior authorization process, call 888-397-8129.
PCA-1-25-00234-Clinical-NN_02112025
