MedicaidPrior AuthMedium impact
North Carolina Medicaid: Prior authorization updates for specialty pharmacy medications
UnitedHealthcare·NC · Hematology, Oncology, Neurology +1 more·State news
Effective date
Dec 1, 2025
We identified it
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.
Action Required
Before December 1, 2025: Update billing system to require prior authorization for the 10 listed specialty gene/cell therapy HCPCS codes. Train staff that Casgevy, Lenmeldy, Lyfgenia, Skysona, and Zynteglo require calling Optum Transplant Services at 888-805-1802 instead of using the UnitedHealthcare Provider Portal. All other therapies use standard portal submission. Prior authorization must be obtained before service date or claims will be denied and providers cannot balance bill members.