Effective July 1, 2022: Medical benefit therapeutic equivalent medications and excluded drugs policy
Learn more about updates to covered medications and lower-cost alternatives based on a recent UnitedHealthcare clinical review.
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.
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:
- New Jersey
- New York
- 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:
|Drug Class||Excluded Medication||Other Options||UnitedHealthcare Commercial|
|7/1/22 Fully Insured|
For more information, please contact your broker or UnitedHealthcare representative.