Specialty medical injectable drug program, requirements and drug policy updates for November
New specialty medical injectable updates and requirements announced November 2023.
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 |
Cosentyx® - IV formulation (secukinumab) |
Used for the treatment of adults with active psoriatic arthritis, active ankylosing spondylitis, and active non-radiographic axial spondyloarthritis with objective signs of inflammation. |
Pombiliti™ (cipaglucosidase alfa-atga) |
Used in combination with Opfolda for the treatment of adult patients with late-onset Pompe disease weighing ≥ 40 kg and who are not improving on their current enzyme replacement therapy. |
Review the UnitedHealthcare Commercial Plan Review at Launch Medication List.
SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO MEDICATION SOURCING FOR OUTPATIENT HOSPITAL PROVIDERS ONLY
For UnitedHealthcare commercial business effective December 1, 2023
| Drug Name | Effective Date | Therapeutic Class | HCPCS Code(s) | Specialty Pharmacy |
Leqembi™ (lecanemab-irmb) |
12/1/23 | Central Nervous System agents | J0174 | Soleo Health |
Review the UnitedHealthcare Commercial Plan Medication Sourcing List.
UPDATES TO DRUG PROGRAM REQUIREMENTS AND DRUG POLICIES
For UnitedHealthcare commercial business effective February 1, 2024
| Drug Name | Treatment Uses | Summary of Changes |
Krystexxa® (pegloticase) |
Used for the treatment of chronic gout in patients refractory to conventional therapy. |
Expand Notification/ Prior Authorization requirement to include all outpatient places of service – home, office, and ambulatory infusion suite in addition to outpatient hospital, which already requires prior authorization. |
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 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.
For questions, please contact your broker or UnitedHealthcare representative.
