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UnitedHealthcareCommercial · Prior Auth · Medical Benefit Drug Policy · Genetics, Endocrinology, Pediatrics +2 moreMedium impact

Genglycos™ (Pariglasgene Brecaparvovec-Opnr)

Effective date
Dec 1, 2026
Identified
Nov 7, 2026

Summary

Surest added Genglycos (pariglasgene brecaparvovec-opnr) to its Review at Launch program for new-to-market medications, so some members may not be eligible for coverage at this time. Coverage criteria for the gene therapy for glycogen storage disease type Ia require patients aged 8 or older, a confirmed GSDIa diagnosis (bi-allelic G6PC variants or absent G6Pase activity on liver biopsy), current cornstarch therapy, no detectable AAV8 capsid antibodies, no prior gene therapy for GSDIa, prescribing or consultation by a metabolic specialist, no planned inpatient admission solely to administer the drug, dosing per FDA labeling, and authorization limited to one lifetime treatment for no more than 45 days from approval. The effective date for the policy is December 1, 2026.

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What to do

Action · 4 steps
01By 2026-12-01: Billing team and providers should review the Review at Launch for New to Market Medications policy titled in the Surest medical benefit drug policy bulletin, since members may not be eligible for Genglycos coverage under the new program.
02Before scheduling Genglycos administration: Confirm each patient meets all listed criteria (age 8 or older, documented GSDIa diagnosis with G6PC genotype or liver biopsy results, current cornstarch regimen, AAV8 antibody status, no prior GSDIa gene therapy, metabolic specialist involvement, no inpatient admission solely for infusion, FDA-labeled dosing) and request authorization in the prior authorization tracker, noting the one-treatment-per-lifetime limit and 45-day authorization window.
03In charge entry and claim preparation: Attach chart notes and laboratory values documenting diagnosis and antibody status to the authorization request so claims match the approved dates and dosing.
04Billing team: Tell providers and front desk staff about the coverage criteria and the December 1, 2026 effective date so scheduling follows authorization.

Original notice

Genglycos™ (Pariglasgene Brecaparvovec-Opnr)
uhcprovider.com · Always check the source before changing claims.
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