Specialty medical injectable drug program, requirements and drug policy updates for April
New specialty medical injectable updates and requirements announced April 2024.
Review the following tables to determine changes to our specialty medical injectable drug programs.
SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO REVIEW AT LAUNCH
For UnitedHealthcare Commercial business
| Drug Name | Treatment Uses |
| Tofidence™ (tocilizumab-bavi) |
Biosimilar for Actemra indicated for the treatment of rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, and systemic juvenile idiopathic arthritis. |
| Tyenne® (tocilizumab-aazg) |
Biosimilar for Actemra indicated for the treatment of rheumatoid arthritis, giant cell arteritis, polyarticular juvenile idiopathic arthritis, and systemic juvenile idiopathic arthritis. |
| Tyruko® (natalizumab-sztn) |
Biosimilar for Tysabri indicated for the treatment of multiple sclerosis and Crohn’s disease. |
Note: Drugs added to Review at Launch may not yet be available in the marketplace.
Review the UnitedHealthcare Commercial Plan Review at Launch Medication List.
For questions, please contact your broker or UnitedHealthcare representative.
SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO MEDICATION SOURCING FOR OUTPATIENT HOSPITAL PROVIDERS ONLY
For UnitedHealthcare commercial business
| Drug Name | Effective Date | Therapeutic Class | HCPC Code(s) | Specialty Pharmacy |
| Cosentyx® IV (secukinumab) |
7/1/2024 |
Inflammatory Conditions | J3490 J3590 C9399 |
TBD |
| Rivfloza™ (nedosiran) |
7/1/2024 | Enzyme Replacement Therapy | J3490 J3590 C9399 |
TBD |
Review the UnitedHealthcare Commercial Plan Medication Sourcing List.
For questions, please contact your broker or UnitedHealthcare representative.
UPDATES TO DRUG PROGRAM REQUIREMENTS AND DRUG POLICIES
For UnitedHealthcare commercial business effective July 1, 2024
| Drug Name | Treatment Uses | Summary of Changes |
| Amtagvi™ (lifileucel) |
Tumor infiltrating lymphocyte therapy used to treat advanced melanoma. | Add prior authorization/ notification Will be managed by Optum Transplant and given inpatient |
| Cosentyx® IV (secukinumab) |
Used for the treatment of patients with psoriatic arthritis, ankylosing spondylitis, or axial spondyloarthritis. | Add prior authorization/ notification Add to Site of Care Add as non-preferred product; Cosentyx® SC is preferred |
Lenmeldy™
|
Gene therapy used to treat children with early-onset metachromatic leukodystrophy. | Add prior authorization/ notification Will be managed by Optum Transplant |
| Rivfloza™ (nedosiran) |
Used to lower urinary oxalate levels in children 9 years of age and older and adults with primary hyperoxaluria type 1 and relatively preserved kidney function. | Add prior authorization/ notification Add to Site of Care |
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. Upon prior authorization renewal, the updated policy will apply.
For questions, please contact your broker or UnitedHealthcare representative.
