UnitedHealthcareMedicaid · Prior Auth · Medical Benefit Drug Policy · KY · Rheumatology, PharmacyMedium impact
Saphnelo® (Anifrolumab-Fnia)
Effective date
Jan 1, 2027
Identified
Nov 7, 2026
Summary
UnitedHealthcare Community Plan of Kentucky revised its Saphnelo (anifrolumab-fnia) medical benefit drug policy for moderate to severe SLE, adding a criterion that the prescriber attest the patient or caregiver cannot be trained or is physically unable to self-administer Saphnelo or Benlysta (FDA-labeled for self-administration) and submit an explanation, for both initial and continuation requests. Practices should update prior authorization submissions for these infusions to include the attestation and explanation, and confirm the patient meets the Benlysta failure/contraindication/intolerance history before requesting authorization.
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01By 2027-01-01: Billing team and rheumatology providers should add the prescriber attestation (patient or caregiver cannot be trained or is physically unable to self-administer Saphnelo or Benlysta) and a written explanation to prior authorization packets for Saphnelo IV infusion requests, both initial and continuation, for Kentucky Medicaid members.
02Before scheduling initial therapy, confirm the member's history of failure, contraindication, or intolerance to Benlysta IV or SQ, and confirm the member is not on a concurrent biologic or Benlysta.
03Front desk and prior auth staff should be told that Saphnelo requests without these elements will not meet the listed criteria and may be denied, and the tracker should be updated to flag these fields.
Original notice
Saphnelo® (Anifrolumab-Fnia)
uhcprovider.com · Always check the source before changing claims.
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