Specialty medical injectable drug program, requirements and drug policy updates Jan 2023
New specialty medical injectable updates and requirements announced.
Review the following table to determine changes to our specialty medical injectable drug programs.
Updates to drug program requirements and drug policies for UnitedHealthcare commercial business effective April 1, 2023
| Drug Name | Treatment Uses | Summary of Changes |
| Hemgenix (etranacogene dezaparvovec) |
Gene therapy used to treat members with hemophilia B without evidence of inhibitors who require chronic prophylaxis. | Add notification/prior authorization and complex and rare disease sourcing. Add notification/prior authorization. |
| Rolvedon™ (eflapegrastim-xnst) |
Indicated to decrease the incidence of infection, as manifested by febrile neutropenia. | Add preferred product: Rolvedon™ is non-preferred: Neulasta® and Ziextenzo® are preferred. |
| Spevigo® (spesolimab-sbzo) |
Used to treat adults with generalized pustular psoriasis (GPP). | Add notification/prior authorization and medication sourcing. |
| Stimufend® (pegfilgrastim-fpgk) |
Indicated to decrease the incidence of infection, as manifested by febrile neutropenia. | Add preferred product: Stimufend® is non-preferred: Neulasta® and Ziextenzo® are preferred. |
| Tzield™ (teplizumab-mzwv) |
Used to delay the clinical onset of Type 1 Diabetes Mellitus (DM) in individuals at high risk for developing the disease. | Add notification/prior authorization, medication sourcing, and site of care. |
| Xenpozyme® (olipudase alfa) |
Used to treat patients with acid sphingomyelinase deficiency (ASMD), a genetic condition, known as Niemann-Pick disease type A, A/B and B. |
Add notification/prior authorization to outpatient facility only (POS 19/22), medication sourcing, and site of care. |
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.
