MedicaidCoverageMedium impact
Adzynma (ADAMTS13, Recombinant-Krhn) (for Ohio Only)
UnitedHealthcare·OH · Hematology, Critical Care, Internal Medicine·Medical Benefit Drug Policy
Effective date
Oct 1, 2026
We identified it
Sep 2, 2026
Summary
UnitedHealthcare Community Plan of Ohio has updated its medical benefit drug policy for Adzynma (ADAMTS13, Recombinant-Krhn), effective October 1, 2026. This is a new policy specific to Ohio Medicaid members. The billing team must review the complete policy document to understand coverage criteria, prior authorization requirements, and any applicable billing codes for this rare disease therapeutic.
Action Required
By September 15, 2026: Billing team must obtain and review the complete policy document from the source URL to identify: (1) specific HCPCS codes for Adzynma administration and infusion, (2) prior authorization requirements and submission process, (3) medical necessity documentation requirements, and (4) any quantity limits or frequency restrictions. Update billing system rules and EMR encounter forms for Ohio Medicaid patients before October 1, 2026. Coordinate with providers who treat thrombotic thrombocytopenic purpura (TTP) to ensure compliance. Claims submitted without adherence to the new requirements may be denied.