Specialty medical injectable drug program, requirements and drug policy updates for January

New specialty medical injectable updates and requirements announced January 2025.

Jan. 25, 2025

Review the following tables to determine changes to our specialty medical injectable medication programs.

Review at launch
The following specialty medical injectable medications have been added to review at launch:

Medication Name HCPCs Code(s)
Pyzchiva®
(ustekinumab-ttwe) Biosimilar to Stelara®

Q9996 (SC)
Q9997 (IV)

Selarsdi™
(ustekinumab-aekn) Biosimilar to Stelara

 Q9998

Note: Medications added to Review at Launch may not yet be available in the marketplace.

Review the UnitedHealthcare Commercial Plan Review at Launch Medication List

Updates to drug program requirements and drug policies
Effective Apr. 1, 2025, the following drug program requirement and drug policy updates will be made to UnitedHealthcare commercial business:

 

Medication Name HCPCs Code(s) Summary of Changes
Aucatzyl®
(obecabtagene autoleucel) 		 J3490/J3590/C9399
  • Add prior authorization/notification
  • Managed by Optum Transplant
PiaSky®
(crovalimab-akkz)		 J1307
  • Add prior authorization/notification
  • Add to site of care
  • Add as non-preferred product; preferred product requirements require utilization of one of the following: Empaveli®, Fabhalta®, Soliris®, or Ultomiris®
Pyzchiva®
(ustekinumab-ttwe)
Biosimilar to Stelara

Q9996 (SC)
Q9997 (IV)
  • Add prior authorization/notification
  • Add to site of care
Selarsdi™
(ustekinumab-aekn)
Biosimilar to Stelara®		 Q9998
  • Add prior authorization/notification
  • Add to site of care
Tofidence™
(tocilizumab-bavi)
Biosimilar to Actemra®

Q5133
  • Add prior authorization/notification
  • Add to site of care
  • Add as non-preferred product; preferred product requirements require utilization of one of the following: Actemra or Tyenne®
Tyenne
(tocilizumab-aazg)
Biosimilar to Actemra		 Q5135
  • Add prior authorization/notification
  • Add to site of care
Wezlana™
(ustekinumab-auub)
Biosimilar to Stelara		 Q5137 (SC)
Q5138 (IV)
  • Add prior authorization/notification
  • Add to site of care

Medication sourcing for outpatient hospital providers only
The following specialty medical injectable medications are being added to Medication Sourcing for outpatient hospital providers only:

Medication Name HCPCs Code(s) Effective Date Specialty Pharmacy

Tremfya® IV

(guselkumab)

 J1628 2/1/25 Accredo Health Group
PiaSky
(crovalimab-akkz)		 J1307 4/1/25 Accredo Health Group
Pyzchiva
(ustekinumab-ttwe)
Biosimilar to Stelara

Q9996 (SC)
Q9997 (IV)

 4/1/25 TBD
Selarsdi
(ustekinumab-aekn)
Biosimilar to Stelara		 Q9998 4/1/25 TBD
Tofidence
(tocilizumab-bavi)
Biosimilar to Actemra		 Q5133 4/1/25 TBD
Tyenne
(tocilizumab-aazg
Biosimilar to Actemra		 Q5135 4/1/25 TBD
Wezlana
(ustekinumab-auub)
Biosimilar to Stelara

Q5137 (SC)
Q5137(IV)

 4/1/25 TBD

Review the UnitedHealthcare Commercial Plan Medication Sourcing List.

For questions, please contact your broker or UnitedHealthcare representative.

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