August 15, 2025
North Carolina Medicaid: Specialty pharmacy updates
State-required prior authorization requirements
Beginning Dec. 1, 2025, we’ll require notification/prior authorization for the following specialty medications for UnitedHealthcare Community Plan in North Carolina:
| Medication | HCPCS code(s) |
|---|---|
| Casgevy® (exagamglogene autotemcel) | J3392 |
| Elevidys™ (delandistrogene moxeparvovec-rokl) | J1413 |
| Hemgenix™ (etranacogene dezaparvovec-drlb) | J1411 |
| Lenmeldy™ (atidarsagene autotemcel) | J3391 |
| Luxturna® (voretigene neparvovec-rzyl) | J3398 |
| Lyfgenia™ (lovotibeglogene autotemcel) | J3394 |
| Roctavian™ (valoctogcogene roxaparvovec-rvox) | J1412 |
| Skysona® (elivaldogene autotemcel) | J3490, J3590, C9399 |
| Zolgensma® (onasemnogene abeparvovec-xioi) | J3399 |
| Zynteglo™ (betibeglogene autotemcel) | J3393 |
How to submit and manage prior authorizations
- Sign in to the UnitedHealthcare Provider Portal with your One Healthcare ID
- If you don’t have a One Healthcare ID, register now
- From the left-hand tabs, select Prior Authorizations & Notifications
For training, view our Prior Authorization and Notification interactive guide.
Please note: For the following cell and gene therapies, you must contact Optum Transplant Services at 888-805-1802 to submit your prior authorization request:
- Casgevy
- Lenmeldy
- Lyfgenia
- Skysona
- Zynteglo
Prior authorization requests must be received before the date of service. If a request is not received in advance, providers are not permitted to balance bill the member if their claim is denied.
Questions? We're here to help.
Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal.
PCA-1-25-01540-M&R-NN_08062025
