Specialty medical injectable drug program requirements and drug policy updates: Nexviazyme®, Saphnelo™ and more
New specialty medical injectable guidelines and requirements announced.
- All states
- Operations
Please review the following information to determine changes to our specialty medical injectable drug programs.
| SPECIALTY MEDICAL INJECTIBLE DRUGS ADDED TO REVIEW AT LAUNCH | ||
|---|---|---|
| Drug Name | UnitedHealthcare Commercial | Treatment Uses |
| Nexviazyme® | X | For the treatment of patients 1 year of age and older with late-onset Pompe disease. |
| Saphnelo™ | X | For the treatment of adult patients with moderate to severe systemic lupus erythematosus, who are receiving standard therapy. |
View the UnitedHealthcare Commercial Plan Review at Launch Medication List.
| Drug Name | Update to Program | Ongoing Management |
|---|---|---|
Eligard® (J9217) Fensolvi® (J1951) Firmagon® (J9155) Lupron Depot® (J1950) Supprelin® (J9226) Trelstar® (J3315) Triptudor® (J3316) Vantas® (J9225) Zoladex® (J9202) |
Remove notification/prior authorization requirement for non-oncology indications. | Coverage will continue to follow the criteria within the medical benefit drug policy posted on UHCProvider.com through claim review. |
Spravato® (S0013) Sublocade® (Q9991/Q9992) Probuphine® (J0570) |
Remove notification/prior authorization requirement. |
Coverage will continue to follow the criteria within the medical benefit drug policy posted on UHCProvider.com through claim review. |
In an effort to streamline access to care and reduce administrative burden, UnitedHealthcare Commercial plans are modifying the Prior Authorization/Notification requirements as noted for the drugs listed above effective 10/1/2021. These changes affect UnitedHealthcare Commercial plan members, including members of affiliate plans, such as UnitedHealthcare of the Mid-Atlantic, Neighborhood Health Partnership and UnitedHealthcare of the River Valley.
Note: Certain specialty medical injectable drug 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. This exception does not apply to Medicaid and Medicare.
More updates for your clients
New releases, updates and notifications for a broad spectrum of UnitedHealthcare products and services.
Important, required notices for products, plans, forms and more.
Need-to-know operational announcements for you and your clients.