Specialty medical injectable drug program, requirements and drug policy updates for August
New specialty medical injectable updates and requirements announced August 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 |
| KisunlaTM (donanemab-azbt) | Used for the treatment of Alzheimer’s disease in patients with mild cognitive impairment or mild dementia state of 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 MEDICAL BENEFIT THERAPEUTIC EQUIVALENT MEDICATIONS – EXCLUDED DRUGS
For UnitedHealthcare commercial business
| Drug Name | Effective Date | Therapeutic Class | HCPCS Code | Other Options |
| Eylea® HD (aflibercept) |
10/1/24 | Ophthalmologic VEGF inhibitors | J0177 | Avastin, Cimerli® (Lucentis biosimilar), Eylea®, Lucentis®, and Vabysmo® |
*This is a reminder; Eylea HD strategy was initially included in the June publication
For questions, please contact your broker or UnitedHealthcare representative.
UPDATES TO DRUG PROGRAM REQUIREMENTS AND DRUG POLICIES
For UnitedHealthcare commercial business
| Drug Name | Effective Date | Treatment Uses | Summary of Changes |
| Eylea HD* (aflibercept) |
10/1/2024 | Used to treat neovascular age-related macular degeneration, diabetic macular edema, and diabetic retinopathy | Add prior authorization/ notification in states where coverage is not excluded Add as a non-preferred product; members must step through therapeutic equivalent alternatives prior to coverage for Eylea® HD |
*This is a reminder; Eylea HD strategy was initially included in the June publication
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.
