MedicaidPrior AuthMedium impact
Provider Letter 2024-06: RE: Prior Authorization of Cerezyme®, ELELYSO®, VPRIV® and ELAPRASE® – Effective April 15, 2024
Oklahoma SoonerCare·OK · Endocrinology, Hematology, Oncology +2 more·Prior Authorization
Effective date
Apr 15, 2024
We identified it
Jun 20, 2026
Summary
Oklahoma Medicaid (SoonerCare) will require prior authorization for four specialized enzyme replacement therapies effective April 15, 2024: Cerezyme, ELELYSO, and VPRIV for Gaucher disease, plus ELAPRASE for Hunter syndrome. Current patients on these therapies will be approved for continuation, but all new treatments require PA with specific diagnostic documentation and specialist involvement.
Action Required
By April 15, 2024: Billing team must implement prior authorization requirements for Cerezyme, ELELYSO, VPRIV, and ELAPRASE for all Oklahoma SoonerCare members. Use PHARM-04 form for pharmacy providers and PHARM-18 form for medical providers. Submit all PA requests to Pharmacy Prior Authorization Unit via fax (not Medical Authorization Unit or online portal). For patients currently on these therapies, submit PA requests for all treatments after April 1, 2024, to avoid therapy disruption. Claims without prior authorization will be denied.