MedicaidCoverageMedium impact
Maryland Medicaid Clinical Coverage Updates for the 1st Quarter 2024
Maryland Medicaid·MD · Endocrinology, Hematology, Oncology·Managed Care Organizations
Effective date
Apr 1, 2024
We identified it
Jun 20, 2026
Summary
Maryland Medicaid added coverage for three new medications effective April 1, 2024: Imcivree (J3490) for monogenic/syndromic obesity, Hemgenix (J1411) for Hemophilia B gene therapy, and Loqtorzi (J3590) for nasopharyngeal carcinoma, plus Udenyca OnBody (Q5111). All four drugs require prior authorization and are reimbursed at rates determined by report.
Action Required
By April 1, 2024: Billing team must update billing system and prior authorization workflows to recognize and require prior auth for HCPCS codes J3490, J3411, J3590, and Q5111 for Maryland Medicaid MCO plans. Update claim submission templates and provider education materials to reflect new covered medications and their specific clinical indications. Configure billing system to process these drugs as "By Report" reimbursement (J3490, J3411, J3590) or at the specified fee rate (Q5111 at $122.10). Without prior authorization submission, claims will be denied by Maryland MCOs.