CurrentColorado Rocky Mountain Health PlansPolicy 2026 P 1268-8

Sucraid (sacrosidase) oral solution - Prior Authorization/Notification - UnitedHealthcare Commercial Plansopen_in_new

Prior authorization/notification policy for Sucraid (sacrosidase) oral solution for treatment of congenital sucrase-isomaltase deficiency (CSID) under UnitedHealthcare Commercial Plans. Defines initial authorization and reauthorization criteria and authorization duration, with note that automated approvals may occur based on claims history.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicySucraid (sacrosidase) oral solution - Prior Authorization/Notification - UnitedHealthcare Commercial Plansopen_in_new

Policy CodePolicy 2026 P 1268-8

Change TypeClarified (annual review, no criteria changes)

Effective DateApr 1, 2026

Next Review Date

Key ActionPrior authorization/notification is required; initial authorization granted only for members with a diagnosis of congenital sucrase-isomaltase deficiency and is issued for 12 months.

SourceLink

POLICY UPDATE CHANGES

Annual reviews through 1/2026 indicate no changes to coverage criteria.

12mAuthorization duration (initial)

12mAuthorization duration (reauthorization)

1Required documented criterion (initial)

1Required documented criterion (reauthorization)

Coverage Summary

Policy applies to Sucraid (sacrosidase) oral solution for treatment of congenital sucrase-isomaltase deficiency (CSID) under UnitedHealthcare Commercial Plans. Sucraid is covered with criteria: initial authorization requires a diagnosis of CSID and is issued for 12 months. Reauthorization requires documentation of a positive clinical response and reauthorizations are issued for 12 months. UnitedHealthcare may use automated approval or re-approval processes based on previous claim/medication history, diagnosis codes (ICD-10) and/or claim logic.

Initial authorization duration12 months

Reauthorization duration12 months

Required documented criterion (initial)Diagnosis of congenital sucrase-isomaltase deficiency (1 criterion)

Required documented criterion (reauthorization)Documentation of positive clinical response to Sucraid therapy (1 criterion)

NotesAutomated approval may occur based on previous claims/medication history, diagnosis codes (ICD-10) and/or claim logic; state mandates and benefit plan coverage may affect criteria.

Initial Therapy Criteria

Initial Authorization

Sucraid will be approved based on the following criterion:

ALL of the following

Diagnosis of congenital sucrase-isomaltase deficiency

Authorization will be issued for 12 months.

Continuation / Reauthorization Criteria

Reauthorization

Sucraid will be approved based on the following criterion:

ALL of the following

Documentation of positive clinical response to Sucraid therapy

Authorization will be issued for 12 months.

Reauthorizations are issued for 12 months and require documentation of a positive clinical response to Sucraid therapy.

Provider Actions & Requirements

Prior Authorization

Prior authorization required for Sucraid

Prior authorization/notification is required. Initial authorization is granted only for members with a diagnosis of congenital sucrase-isomaltase deficiency (CSID) and is issued for 12 months.

Documentation Required

Reauthorization documentation

Reauthorization requires documentation of a positive clinical response to Sucraid therapy. Reauthorizations are issued for 12 months.

Applicable Codes

Relevant diagnosis codes (policy references ICD-10 codes for automated approval logic)ICD-10

No codes listed

Clinical Evidence & References

Sucraid (sacrosidase) is an oral enzyme replacement therapy indicated for the treatment of sucrase deficiency as part of congenital sucrase-isomaltase deficiency (CSID). The effects of Sucraid have not been evaluated in patients with secondary (acquired) sucrase deficiency. Reference: Sucraid [package insert], QOL Medical, LLC; August 2024.

Definitions & Scope

CSID = Congenital sucrase-isomaltase deficiency. This policy applies to UnitedHealthcare Commercial Plans.

Revision History

2018-12-01P&T approval

Program created; Prior Authorization/Notification - Sucraid new program (P&T approval 12/2018).

2019-12-01P&T approval

Annual review with no changes to coverage criteria (P&T approval 12/2019).

2021-01-01P&T approval

Annual review; updated references (P&T approval 1/2021).

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicySucraid (sacrosidase) oral solution - Prior Authorization/Notification - UnitedHealthcare Commercial Plansopen_in_new

Policy CodePolicy 2026 P 1268-8

Change TypeClarified (annual review, no criteria changes)

Effective DateApr 1, 2026

Next Review Date

Key ActionPrior authorization/notification is required; initial authorization granted only for members with a diagnosis of congenital sucrase-isomaltase deficiency and is issued for 12 months.

SourceLink

On This Page

Prior Authorization

Automated approval allowance

UnitedHealthcare may approve initial and reauthorization based solely on prior claim/medication history, diagnosis codes (ICD-10) and/or claim logic. Use of automated approval and re-approval processes varies by program and/or therapeutic class.

Documentation Required

State and benefit limitations

State mandates, federal regulatory requirements, and the member-specific benefit plan coverage may impact coverage criteria. Other policies and utilization management programs may also apply.

2022-01-01P&T approval

Annual review with no changes to coverage criteria (P&T approval 1/2022).

2023-01-01P&T approval

Annual review with no changes to coverage criteria; added state mandate footnote and updated reference (P&T approval 1/2023).

2024-01-01P&T approval

Annual review with no changes to coverage criteria; updated reference (P&T approval 1/2024).

2025-01-01P&T approval

Annual review with no changes to coverage criteria; updated background and reference (P&T approval 1/2025).

2026-01-01P&T approvalLatest

Annual review with no changes to coverage criteria (P&T approval 1/2026).

2026-01-01review noteLatest

Annual reviews through 1/2026 indicate no changes to coverage criteria.

2026-04-01effective dateLatest

Policy effective date 4/1/2026.