MedicaidCoverageMedium impact
Itvisma® (Onasemnogene Abeparvovec-Brve)
UnitedHealthcare·Pediatrics, Genetics, Neurology·Medical Benefit Drug Policy
Effective date
Oct 1, 2026
We identified it
Sep 2, 2026
Summary
UnitedHealthcare Community Plan (Medicaid) has issued a revised medical policy for Itvisma® (Onasemnogene Abeparvovec-Brve), a gene therapy treatment. The policy becomes effective October 1, 2026. The billing team must review the full policy document to identify coverage criteria, prior authorization requirements, and applicable billing codes for this newly revised benefit.
Action Required
By September 15, 2026: Billing team must obtain and review the complete policy text from the source URL to identify: (1) specific HCPCS or CPT codes for Itvisma administration, (2) prior authorization requirements and process, (3) medical necessity documentation requirements, and (4) any member eligibility restrictions. Update billing system with coverage rules, add prior auth workflow if required, and brief clinical and administrative staff on the new coverage effective October 1, 2026. Failure to implement coverage criteria may result in claim denials.