Specialty medical injectable drug program, requirements and drug policy updates for June
New specialty medical injectable updates and requirements announced June 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 |
| Beqvez™ (fidanacogene elaparvovec-dzkt) |
Gene therapy used to treat adults with moderate to severe hemophilia B |
Review the UnitedHealthcare Commercial Plan Review at Launch Medication List.
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® |
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 |
Added prior authorization/ notification in states where coverage is not excluded. Added as a non-preferred product; members must step through therapeutic equivalent alternatives prior to coverage for Eylea® HD. |
| Winrevair® (sotatercept-csrk) |
5/20/2024 | Used to treat adults with pulmonary arterial hypertension | Winrevair was removed from the Review at Launch program and added to the self-administered policy due to the ability to self-administer this medication. Members will be referred to the pharmacy benefit for coverage. |
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.
SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO MEDICATION SOURCING FOR OUTPATIENT FACILITY PROVIDERS ONLY
For UnitedHealthcare Commercial business
| Drug Name | Effective Date | Therapeutic Class | HCPC Code(s) | Specialty Pharmacy |
| Cosentyx® IV formulation (secukinumab) |
7/1/2024 | Inflammatory conditions |
J3247 |
Caremark (CVS Specialty) |
| Rivfloza™ (nedosiran) |
7/1/2024 | Endocrine | J3490 |
Caremark (CVS Specialty) |
Review the UnitedHealthcare Commercial Plan Medication Sourcing List.
For questions, please contact your broker or UnitedHealthcare representative.
