MedicaidPrior AuthMedium impact
Carve Out and Preauthorization of Spinraza and Cinryze
Maryland Medicaid·MD · Neurology, Allergy & Immunology, Hematology·Provider Transmittal
We identified it
Jun 20, 2026
Summary
Maryland Medicaid is implementing new carve out policies and preauthorization requirements for Spinraza (nusinersen) and Cinryze (C1 esterase inhibitor) medications. These specialty drugs will now require prior authorization before administration and may be carved out from standard pharmacy benefits.
Action Required
Immediately: Billing team must obtain prior authorization from Maryland Medicaid before administering Spinraza or Cinryze medications. Update billing workflows to verify authorization status before treatment. Contact Maryland Medicaid for specific authorization procedures and required documentation. Claims submitted without proper preauthorization will be denied.