Specialty Pharmacy Updates for North Carolina Medicaid
Starting Dec 01, 2025, UnitedHealthcare Community Plan in North Carolina will require notification/prior authorization for the following specialty medications:
| 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 using your One Healthcare ID.
- If you don’t have an ID, you can register for one.
- From the left menu, select Prior Authorizations & Notifications.
For training, providers can view the Prior Authorization and Notification interactive guide.
They must contact Optum Transplant Services (888-805-1802) to submit prior authorization requests for the following cell and gene therapies:
- Casgevy
- Lenmeldy
- Lyfgenia
- Skysona
- Zynteglo
All prior authorization requests must be submitted before the date of service. If a request is not submitted in advance and the claim is denied, providers cannot balance bill the member.
For more information, providers can connect with UnitedHealthcare through 24/7 chat in the Provider Portal.
