Specialty medical injectable medication program, requirement and policy updates, Oct. 2025

Review the following tables to determine changes to our specialty medical injectable medication programs and drug policy updates for October 2025.

Oct. 27, 2025

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

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

Medication Name HCPCs Code(s)
Avtozma®
(tocilizumab-anoh) Biosimilar to Actemra®		 Q5156
Conexxence®
(denosumab-bnht) Biosimilar to Prolia®		 Q5158
Papzimeos®
(zopapogene imadenovec-drba)

J3490/J3590/C9399
Ospomyv®
(denosumab-dssb) Biosimilar to Prolia		 Q5159
Yesafili®
(aflibercept-jbvf)Biosimilar to Eylea®

Q5155

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

Review the UnitedHealthcare Commercial Plan Review at Launch Medication List.

Medical Benefit Therapeutic Equivalent Medications – Excluded Drugs
Effective January 1, the following specialty injectable medications are being added to Medical Benefit Therapeutic Equivalent Medications – Excluded Drugs for UnitedHealthcare commercial business: 

Medication Name HCPCs Code(s) Therapeutic Class Other Options
Azmiro®
(testosterone cypionate)		 J1072 Endocrine Generic testosterone cypionate, brand Depo®-Testosterone
Daxxify®
(daxibotulinumtoxinA-lanm)		 J0589 Botulinum toxins A and B Dysport®, Xeomin®, Botox®
Jubbonti®
(denosumab-bbdz)Biosimilar to Prolia)		 Q5136

1/1/25
Prolia, Stoboclo®

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

Medication Name Code(s) Summary of Changes
Alhemo®
(concizumab-mtci)		 J7173
  • Add prior authorization/notification
Azmiro
(testosterone cypionate)		 J1072
  • Add prior authorization/notification
  • For Commercial plan members with benefit plans that do not allow exclusion from coverage:
    • Add prior authorization/notification
    • Add to Site of Care
    • Add as non-preferred product; members must step through generic testosterone cypionate or brand Depo-Testosterone prior to coverage
Bkemv™
(eculizumab-aeeb) Biosimilar to Soliris®		 Q5139
  • Add prior authorization/notification
  • Add to Site of Care
Daxxify
(daxibotulinumtoxinA-lanm)		 J0589
  • Add prior authorization/notification
  • For Commercial plan members with benefit plans that do not allow exclusion from coverage:
    • Add prior authorization/notification
    • Add as non-preferred product; members must step through Dysport, Xeomin and Botox prior to coverage
Epysqli®
(eculizumab-aagh) Biosimilar to Soliris		 Q5151
  • Add prior authorization/notification
  • Add to Site of Care
Imuldosa®
(ustekinumab-srlf) Biosimilar to Stelara®		 Q5098
  • Add prior authorization/notification
  • Add Site of Care
  • Add as non-preferred product; members must step through Steqeyma® or Yesintek™ prior to coverage
Jubbonti
(denosumab-bbdz)		 Q5136
  • Add prior authorization/notification
  • For Commercial plan members with benefit plans that do not allow exclusion from coverage:
    • Add to Site of Care
    • Add as non-preferred product; members must step through Prolia and Stoboclo prior to coverage
Kebilidi™
(eladocagene exuparvovec-tneq)		 J3490/J3590/C9399
  • Add prior authorization/notification
  • Managed by Optum Transplant
  • Part of the Cell, Gene & Molecular Centers of Excellence
Myobloc®
(rimabotulinumtoxinB)		 J0587
  • Add prior authorization/notification
  • Add as non-preferred product; members must step through Dysport, Xeomin, or Botox prior to coverage
Soliris
(eculizumab)		 J1299
  • Will move to a non-preferred product; members must step through Bkemv and Epysqli prior to coverage
Starjemza™
(ustekinumab-hmny) Biosimilar to Stelara®		 J3490/J3590/C
  • Add prior authorization/notification
  • Add Site of Care
  • Add as non-preferred product; members must step through Steqeyma or Yesintek prior to coverage
Susvimo®
(ranibizumab)		 J2779
  • Add prior authorization/notification
Tyruko®
(natalizumab-sztn) Biosimilar to Tysabri®

Q5134
  • Add prior authorization/notification in outpatient hospital place of service
  • Add as non-preferred product; members must step through Tysabri prior to coverage
Yimmugo®
(immune globulin intravenous, human-dira)		 J3490/J3590/C9399
  • Add prior authorization/notification
  • Add to Site of Care
  • Add as non-preferred product; members must step through all preferred IVIG products prior to coverage

UHC will honor all approved prior authorizations/notifications on file until the earlier of the end date on the authorization/notification 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. UHC encourages providers practicing in Rhode Island to call in to confirm if prior authorization/notification is required.

Medication sourcing for outpatient hospital providers only
Effective January 1, the following specialty medical injectable medications are being added to Medication Sourcing for all outpatient providers for UnitedHealthcare commercial business:

Medication Name HCPCs Code(s) Specialty Pharmacy
Azmiro
(testosterone cypionate)		 J1072

TBD
Bkemv
(eculizumab-aeeb)

Q5152

TBD
Epysqli
(eculizumab-aagh)

Q5151

TBD
Susvimo
(ranibizumab)

J2779

 Caremark (CVS Specialty)
Optum Specialty Pharmacy
Jubbonti
(denosumab-bbdz)

Q5136

TBD
Myobloc
(rimabotulinumtoxinB)

J0587

 Amber Specialty Pharmacy
Option Care Health
Daxxify
(daxibotulinumtoxinA-lanm)

J0589

Optum Specialty Pharmacy
Starjemza
(ustekinumab-hmny)

J3490/J3590/C9399

TBD
Imuldosa
(ustekinumab-srlf)

Q5098

TBD

Review the UnitedHealthcare Commercial Plan Medication Sourcing List.

For questions, please contact your broker or UnitedHealthcare representative.

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