Specialty medical injectable drug program updates: Nexviazyme®, Ryplazim® and more

New specialty medical injectable guidelines and requirements announced.

Please review the following table to determine changes to our specialty medical injectable drug programs.

For UnitedHealthcare commercial business effective Jan. 1, 2022

Drug Name

Treatment Uses

Summary of Changes

Nexviazyme® (avalglucosidase alfa-ngpt)

Indicated to treat patients 1 year of age and older with late-onset Pompe disease to help reduce glycogen accumulation in muscle cells.

  • Add notification/prior authorization requirement and Site of Care.
Ryplazim® (plasminogen, human tvmh) Indicated to treat plasminogen deficiency type 1 (hypoplasminogenemia).  
  • Add notification/prior authorization requirement and Site of Care.
Saphnelo™ (anifrolumab-fnia)

Indicated for the treatment of adult patients with moderate to severe systemic lupus erythematosus (SLE).

  • Add notification/prior authorization requirement and Site of Care.

Upon prior authorization renewal, the updated policy will apply. UnitedHealthcare will honor all approved prior authorizations on file until the end date on the authorization or the date the member’s eligibility changes. Providers don’t need to submit a new notification/prior authorization request for members who already have an authorization for these medications on the effective date noted above.

Note: Certain specialty medical injectable drug programs and updates will not be implemented at this time for providers practicing in Rhode Island, with respect to certain commercial members, pursuant to the Rhode Island regulation: 230 -RICR-20-30-14. UnitedHealthcare encourages providers practicing in Rhode Island to call in to confirm if prior authorization is required. This exception does not apply to Medicaid and Medicare. 

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