MedicaidPrior AuthMedium impact
Provider Letter 2026-06: RE: Prior Authorization or Certain Intravenous and Subcutaneous Immunoglobulins Effective May 1, 2026
Oklahoma SoonerCare·OK · Allergy & Immunology, Rheumatology, Neurology +2 more·Prior Authorization
Effective date
May 1, 2026
We identified it
Jun 20, 2026
Summary
Oklahoma Medicaid will require prior authorization for 9 specific immunoglobulin products (including Alyglo, Asceniv, Bivigam, Cuvitru, Gammaplex, Hizentra, Octagam, Panzyga, and Xembify) starting May 1, 2026. Providers must use Form PHARM-322 and meet specific approval criteria including documentation of prior stabilization or clinical reasons why preferred products cannot be used.
Action Required
Before May 1, 2026: For Oklahoma SoonerCare patients, billing team must update workflow to require prior authorization for Alyglo, Asceniv, Bivigam, Cuvitru, Gammaplex, Hizentra, Octagam, Panzyga, and Xembify immunoglobulin products. Download Form PHARM-322 from OHCA pharmacy forms page. Fax PA requests to Pharmacy Prior Authorization Unit (not Medical Authorization Unit). For SoonerSelect health plan members, use their specific PA process instead. Failure to obtain prior auth will result in claim denials.