Optum to manage prior authorization requests for non-oncology injectable medications

UnitedHealthcare Community Plan of Maryland

Starting Sept. 1, 2025, when submitting prior authorization requests for non-oncology physician-administered drugs (PADs) in an outpatient setting through the UnitedHealthcare Provider Portal, please select Specialty Pharmacy as the prior authorization type. Outpatient drug requests will be managed through the Optum® Specialty Guidance Program (SGP), an evidence-based prior authorization request tool used by UnitedHealthcare plans. SGP will help ensure a streamlined, simplified experience for these requests.

This applies to UnitedHealthcare Community Plan of Maryland.

Please note that this change does not apply to the prior authorization request process for oncology-related medications.

How to submit your requests

• Sign in to the portal using your One Healthcare ID and password
• Click the Prior Authorization tab on the left side of the page and select Specialty Pharmacy
• Enter the required information

What this means for existing prior authorization submissions

Prior authorizations submitted before Sept. 1, 2025, will remain in effect. You won’t need to submit a new request until the existing authorization expires or you change the member’s therapy. Changes in therapy include dose, frequency of administration and place of therapy.

Resources

• Medical necessity determinations for prior authorization requests are based on clinical guidelines. Appeal rights may apply.

• Visit Specialty Pharmacy – Medical Benefit Management (Provider Administered Drugs)

Questions?

If you have questions, please call at 888-397-8129, 8 a.m.–8 p.m. ET, Monday–Friday, or email specialtyguidanceprogram@optum.com.