CurrentUCarePolicy N/A

Medicalinjectabledrugauthorizationlist?V=6B5D884B

A maintained list of medical-benefit injectable drugs that typically require prior authorization or step therapy when administered in the provider's office. It lists drugs with their HCPCS codes and provides submission routes for authorization requests; not all drugs on the medical benefit require authorization (only those on this list).

Policy Summary

PayerUCare

PolicyMedicalinjectabledrugauthorizationlist?V=6B5D884B

Policy CodePolicy N/A

Change TypeClarified (last updated)

Effective Date

Next Review Date

Key ActionProviders must obtain prior authorization or step therapy approval for drugs on this list before dispensing or administering under the medical benefit; follow participating or non-participating provider submission routes.

SourceLink

POLICY UPDATE CHANGES

List last updated on 04/01/2026.

400+Drugs/HCPCS codes listed

1Primary submission portal (OnePA)

3Submission routes (portal/fax/phone)

Policy summary

This document is a maintained list of medical-benefit injectable drugs that are typically administered in the provider’s office and require prior authorization or step therapy before they can be dispensed or given. Drugs not found on this list do not require medical-benefit authorization; providers should consult the broader medical drug policy for clinical criteria and routing guidance.

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HCPCS code list (medical-benefit injectables)

Listed HCPCS codes (authorization typically required)HCPCSCovered

Q2055	Abecma
J9264	Abraxane
J3262	Actemra
J0801	Acthar Gel
J0791	Adakveo
J9042	Adcetris
J9029	Adstiladrin
J7171	Adzynma
J1931	Aldurazyme
J9057	Aliqopa

1–10 of 302

1/31

Codes listed as NOC (no official code)HCPCS

NOC	Amtagvi
NOC	Andembry
NOC	Dawnzera
NOC	Encelto
NOC	Exdensur
NOC	Imcivree
NOC	Kebilidi
NOC	Leqembi IQLIK
NOC	Omisirge
NOC	Onapgo

1–10 of 18

1/2

For medical-benefit billing, use the HCPCS codes listed in this document for each product; entries labeled NOC indicate no official HCPCS code and should be billed per payer instructions. Some products are cross-listed (for example, Procrit / Gammaked / Gamunex‑C) — follow the payer’s guidance for the correct code to use.

Authorization submission & billing rules

Prior Authorization

Prior Authorization Required

Providers must obtain prior authorization or step therapy approval for drugs on this list before dispensing or administering under the medical benefit; follow participating or non-participating provider submission routes.

Prior authorization or step therapy approval required before dispensing or administration for drugs listed on the Medical Injectable Drug Authorization List

Documentation Required

How to submit authorization

Participating providers: use OnePA Portal (ePA), fax to Care Continuum at 1-877-266-1871, or call Care Continuum at 1-800-818-6747. Non-participating providers: fax authorization request to UCare at 612-617-3948.

Participating providers: OnePA Portal (ePA), fax to Care Continuum 1-877-266-1871, or call Care Continuum 1-800-818-6747
Non-participating providers: fax to UCare 612-617-3948

Billing Rule

Medical benefit vs drug benefit routing

Drugs not found on this list do not require authorization through the medical benefit; this list governs medical-benefit injectable drugs that typically need authorization.

Documentation Required

State Public Programs exception note

Additional qualifications may apply for State Public Programs due to Fact Code 4 status; Fact Code 4 products may be considered excluded under the UCare medical benefit and providers should review the MHCP fee schedule prior to submission.

Refer to Fact Code 4 (products with 'general price not covered')
Review the MHCP fee schedule prior to submission