Specialty medical injectable medication program, requirement and policy updates January 2026

Review the following tables to determine changes to our specialty medical injectable medication programs and drug policy updates for January 2026.

Review the following tables to determine changes to our specialty medical injectable medication programs and drug policy updates.

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

Medication Name HCPCs Code(s)
Eydenzelt™
(aflibercept-boav)
Biosimilar to Eylea®

J3490/J3590/C9399

Itvisma®
(onasemnogene abeparvovec-brve)
J3490/J3590/C9399
Opuviz™
(aflibercept-yszy)
Biosimilar to Eylea

J3490/J3590/C9399

Osvyrti®
(denosumab-desu)
Biosimilar to Prolia®
J3490/J3590/C9399
Qivigy®
(immune globulin intravenous, human-kthm)

J3490/J3590/J1599/C9399

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

Updates to drug program requirements and drug policies
Effective Apr. 1, 2026, the following drug program requirements and drug policy updates will be made to UnitedHealthcare commercial business:

Medication Name HCPCs Code(s) Summary of Changes
Gazyva®
(obinutuzumab)
J9301
  • Add prior authorization/ notification
Imaavy™
(nipocalimab-aahu)

J9256

  •  Add prior authorization/ notification
  • Add to Site of Care
Papzimeos™
(zopapogene imadenovec-drba)

J3490/J3590/C9399

  • Add prior authorization/ notification

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 Apr. 1, 2026, the following specialty medical injectable medications are being added to Medication Sourcing for Outpatient Hospital Providers Only:

Medication Name HCPCs Code(s) Specialty Pharmacy
Gazyva
(obinutuzumab)
J9301 Accredo Health Group
Amber Specialty PharmacyOptum Specialty Pharmacy
Imaavy
(nipocalimab-aahu)

J9256

Accredo Health Group

Papzimeos™
(zopapogene imadenovec-drba)

J3490/J3590/C9399

Biologics, Inc.

Tyruko
(natalizumab-sztn)
Biosimilar to Tysabri®
Q5134 TBD

Review the UnitedHealthcare Commercial Plan Medication Sourcing List.

For questions, please contact your broker or UnitedHealthcare representative.

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