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North Carolina Medicaid: Prior authorization updates for specialty pharmacy medications
Effective date
Dec 1, 2025
Identified
Jan 12, 2026
Summary
Starting December 1, 2025, UnitedHealthcare Community Plan in North Carolina will require prior authorization for 10 specialty gene and cell therapy medications. Some therapies require contacting Optum Transplant Services directly at 888-805-1802 instead of using the standard portal.
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What to do
Action · 4 steps
01Before December 1, 2025: Update billing system to require prior authorization for the 10 listed specialty gene/cell therapy HCPCS codes.
02Train staff that Casgevy, Lenmeldy, Lyfgenia, Skysona, and Zynteglo require calling Optum Transplant Services at 888-805-1802 instead of using the UnitedHealthcare Provider Portal.
03All other therapies use standard portal submission.
04Prior authorization must be obtained before service date or claims will be denied and providers cannot balance bill members.
Codes mentioned
J3392J1413J1411J3391J3398J3394J1412J3490J3590C9399J3399J3393
Original notice
North Carolina Medicaid: Prior authorization updates for specialty pharmacy medications
uhcprovider.com · Always check the source before changing claims.
Related changes
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