Specialty medical injectable drug program, requirements and drug policy updates
New specialty medical injectable updates and requirements announced.
Review the following tables to determine changes to our specialty medical injectable drug programs.
SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO REVIEW AT LAUNCH
| Drug Name | UnitedHealthcare Commercial | Treatment Uses |
| AltuviiioTM (Antihemophilic Factor [recombinant], Fc-VWF-XTEN fusion protein-ehtl) |
X | Indicated for routine prophylaxis and on-demand treatment to control bleeding episodes, as well as perioperative management (surgery) for adults and children with hemophilia A. |
| Lamzede® (velmanese alfa) | X | Indicated for the treatment of the non-neurological effects of alpha-mannosidosis, a rare genetic condition characterized by the lack of alpha-mannosidase enzyme in the body. |
| SyfovreTM (pegcetacoplan) | X | Indicated for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD). |
Review the UnitedHealthcare Commercial Plan Review at Launch Medication List.
SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO MEDICATION SOURCING FOR OUTPATIENT HOSPITALS
For UnitedHealthcare commercial businesses effective July 1, 2023
| Drug Name | Therpautic Class | HCPC Code(s) | Specialty Pharmacy |
| Sunlenca® | HIV | J3490 J3590 C9399 |
To be determined |
Review the UnitedHealthcare Commercial Plan Medication Sourcing List.
UPDATES TO DRUG PROGRAM REQUIREMENTS AND DRUG POLICIES
For UnitedHealthcare commercial business effective July 1, 2023
| Drug Name | Treatment Uses | Summary of Changes |
| Lanreotide | Long-term treatment of patients with acromegaly who have an inadequate response to or cannot be treated with surgery and/or radiotherapy. The treatment of adult patients with unresectable, well or moderately differentiated, locally advanced or metastatic gastroenteropancreatic neuroendocrine tumors. |
Add notification/prior authorization Add preferred product:
Note: Oncology use will be managed through Cancer Guidance Program. |
| Lamzede® (velmanese alfa) | Indicated for, in combination with other antiretroviral(s), the treatment of HIV-1 infection in heavily treatment-experienced adults with multidrug resistant HIV-1 infection failing their current antiretroviral regimen due to resistance, intolerance, or safety considerations. | Add notification/prior authorization, Site of Care and Medication Sourcing |
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 do not 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.
For questions, please contact your broker or UnitedHealthcare representative.
