MedicaidCoverageMedium impact
HealthChoice Carve-In for Cinryze® and Spinraza®
Maryland Medicaid·MD · Allergy & Immunology, Neurology, Pediatrics·Provider Transmittal
We identified it
Jun 20, 2026
Summary
Maryland Medicaid has implemented a HealthChoice carve-in for Cinryze® (hereditary angioedema treatment) and Spinraza® (spinal muscular atrophy treatment), meaning these medications will now be covered under managed care plans rather than fee-for-service Medicaid. This affects billing and authorization processes for these high-cost specialty drugs.
Action Required
Immediately: Review the full Provider Transmittal document to understand new billing procedures for Cinryze® and Spinraza®. Update authorization workflows to route requests through HealthChoice managed care plans instead of traditional Medicaid fee-for-service. Billing team must verify patient's specific HealthChoice plan before submitting claims for these medications.