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Genglycos ™ (Pariglasgene Brecaparvovec-Opnr)
Effective date
Dec 1, 2026
Identified
Nov 7, 2026
Summary
UnitedHealthcare Community Plan of Pennsylvania added a Medicaid medical benefit policy for Genglycos (pariglasgene brecaparvovec-opnr) for glycogen storage disease type Ia, effective 2026-12-01. Coverage is limited to patients 8 years or older with a confirmed diagnosis, documented by bi-allelic G6PC variants or absent G6Pase activity on liver biopsy, who are on cornstarch therapy, have no detectable AAV8 antibodies, have never received gene therapy for GSDIa, are managed by or with a metabolic specialist, and are dosed per FDA labeling. Authorization covers one lifetime treatment and no more than 45 days from approval.
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What to do
Action · 4 steps
01By 2026-12-01: Billing team should review the Genglycos criteria with the metabolic and genetics providers who may order it, and have them document the G6PC genotype or liver biopsy enzyme result, cornstarch regimen, AAV8 antibody status, prior gene therapy history, and specialist involvement in the chart before any request is submitted.
02Before scheduling any Genglycos administration for these members: Front desk and scheduling staff should confirm the planned dose matches FDA labeling and that no inpatient admission is being requested solely to administer the drug, and the billing team should obtain the authorization, noting it is limited to one lifetime treatment and 45 days from approval, in the prior authorization tracker.
03In charge entry and claim edits: Confirm the drug's HCPCS code and the authorization number are linked on the claim so the authorization window and single-lifetime limit are respected.
04Claims without the required criteria documentation or authorization will not meet the policy's coverage conditions.
Original notice
Genglycos ™ (Pariglasgene Brecaparvovec-Opnr)
uhcprovider.com · Always check the source before changing claims.
Related changes
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