MedicaidPrior AuthHigh impact
Carve Out and Preauthorization of Zolgensma
Maryland Medicaid·MD · Neurology, Pediatrics, Genetics·Provider Transmittal
We identified it
Jun 20, 2026
Summary
Maryland Medicaid has implemented a carve-out policy for Zolgensma (gene therapy for spinal muscular atrophy) requiring preauthorization. This high-cost specialty drug will now require prior approval before administration and billing to Maryland Medicaid.
Action Required
Immediately: Billing team must obtain preauthorization from Maryland Medicaid before administering Zolgensma gene therapy. Update billing system to flag Zolgensma claims for prior auth verification. Notify providers that claims will be denied without proper preauthorization. Contact Maryland Medicaid provider services for specific preauthorization procedures.