Effective July 1, 2022: Medical benefit therapeutic equivalent medications and excluded drugs policy

UnitedHealthcare is committed to providing members with access to high-quality medications at the lowest possible cost, but in some cases, there are lower-cost options available for coverage when there are multiple medications that are used to treat the same condition. Due to the results of a recent clinical review and the availability of lower-cost alternatives, UnitedHealthcare will be changing coverage for select members.

Who’s affected?

These changes affect UnitedHealthcare Commercial fully insured plan members, including members of affiliate plans, such as UnitedHealthcare of the Mid-Atlantic, UnitedHealthcare Oxford and Neighborhood Health Partnership. In the following states, a clinical review will be made available for fully insured members according to applicable state requirements:

• California
• Colorado
• Connecticut
• Maryland
• New Jersey
• New York
• Virginia

Important considerations

• All approved prior authorizations for the non-covered medication will be honored until the end date on the authorization or the date the member’s eligibility changes.
• This change applies whether a member is new to therapy or has already been receiving the medication.
• Notification/prior authorization for the other suggested medication options listed may be required.
• Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service

Outlined below are the upcoming changes to covered medications, effective July 1, 2022, including suggested alternatives:

For more information, please contact your broker or UnitedHealthcare representative.