Specialty medical injectable medication program, requirement and policy updates April 2025
Review the following tables to determine changes to our specialty medical injectable medication programs and drug policy updates for April 2025.
Review at launch
The following specialty medical injectable medications have been added to Review at Launch:
| Medication Name | HCPCs Code(s) |
| Ahzantive™ (aflibercept-mrbb) Biosimilar to Eylea® |
Q5150 |
| Bkemv™ (eculizumab-aeeb) Biosimilar to Soliris® |
Q5152 |
| Enzeevu™ (aflibercept-abzv) Biosimilar to Eylea |
Q5149 |
| Epysqli® (eculizumab-aagh Biosimilar to Soliris |
Q5151 |
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.
For questions, please contact your broker or UnitedHealthcare representative.
Updates to drug program requirements and drug policies
Effective Jul. 1, 2025, the following drug program requirements and drug policy updates will be made to UnitedHealthcare commercial business:
| Medication Name | HCPCs Code(s) | Summary of Changes |
| Hympavzi™ (marstacimab-hncq) |
J3490/J3590/C9304 |
|
| Niktimvo™ (axatilimab-csfr) |
J9038 |
|
| Ryoncil® (remestemcel-l-rknd) |
J3490/J3590/C9399 |
|
| Stelara® (ustekinumab) |
J3357, J3358 |
|
| Non-preferred ustekinumab products - Biosimilars to Stelara | ||
| Otulfi™ (ustekinumab-aauz) |
Q9999 |
|
| Pyzchiva® (ustekinumab-ttwe) |
Q9996, Q9997 | |
| Selarsdi™ (ustekinumab-aekn) |
Q9998 | |
| Wezlana™ (ustekinumab-auub) |
Q5137, Q5138 | |
Preferred ustekinumab products - Biosimilars to Stelara |
||
| Steqeyma (ustekinumab-stba) |
J3590/C9399 |
|
| Yesintek (ustekinumab-kfce) |
J3590/C9399 | |
UnitedHealthcare will honor all approved prior authorizations on file until the end date on the authorization or the date the member’s eligibility changes. Upon prior authorization renewal, the updated policy will apply.
Note: Certain specialty medical injectable medication programs and updates will not be implemented at this time for providers practicing in Rhode Island, with respect to certain commercial members, pursuant to the Rhode Island regulation: 230-RICR-20-30-14. UnitedHealthcare encourages providers practicing in Rhode Island to call in to confirm if prior authorization is required.
Medication Sourcing for Outpatient Hospital Providers Only
Effective Jul. 1, 2025, the following specialty medical injectable medications are being added to Medication Sourcing for Outpatient Hospital Providers Only:
| Medication Name | HCPCs Code(s) | Specialty Pharmacy |
| Niktimvo (axatilimab-csfr) |
J9038 | TBD
|
| Otulfi (ustekinumab-aauz) Biosimilar to Stelara |
Q9999 | TBD
|
| Pyzchiva (ustekinumab-ttwe) Biosimilar to Stelara |
Q9996, Q9997 |
TBD
|
| Selarsdi (ustekinumab-aekn) Biosimilar to Stelara |
Q9998 | TBD
|
| Steqeyma (ustekinumab-stba) Biosimilar to Stelara |
J3590/C9399 | TBD |
Wezlana |
Q5137, Q5138 | TBD |
| Yesintek (ustekinumab-kfce) Biosimilar to Stelara |
J3590/C9399 | TBD |
Review the UnitedHealthcare Commercial Plan Medication Sourcing List.
For questions, please contact your broker or UnitedHealthcare representative.