Specialty medical injectable drug program requirements and drug policy updates: Ryplazim®, Cabenuva™ and more

New specialty medical injectable guidelines and requirements announced.

July 26, 2021
  • All states
  • Operations

Please review the following information to determine changes to our specialty medical injectable drug programs.

Specialty medical injectable drugs added to review at launch
Drug Name Treatment Uses
Ryplazim® (plasminogen, human-tvmh) Used to treat plasminogen deficiency type 1 (hypoplasminogenemia)

View the UnitedHealthcare Commercial Plan Review at Launch Medication List.

 
Updates to drug program requirements and drug policies
Drug Name Effective Date Treatment Uses Summary of Changes
Cabenuva™ (cabotegravir/ rilpivirine) Oct. 1, 2021 Used to treat human immunodeficiency virus type 1 (HIV-1) infection in adults to replace a current antiretroviral regimen in those who are virologically suppressed on a stable antiretroviral regimen with no history of treatment failure and with no known or suspected resistance to either cabotegravir or rilpivirine.  
  • Add notification/prior authorization requirement
  • Add Site of Care requirement
Evkeeza™(evinacumab-dgnb) Oct. 1, 2021 Used as an add-on treatment for patients aged 12 years and older with homozygous familial hypercholesterolemia (HoFH), a genetic condition that causes severely high cholesterol.
  • Adding notification/prior authorization requirement.
  • Add Site of Care requirement
Nulibry™ (fosdenopterin) Oct. 1, 2021 Reduce the risk of mortality in patients with molybdenum cofactor deficiency (MoCD) Type A.
  • Adding notification/prior authorization requirement.
  • Add Site of Care requirement
Prolia® (denosumab) Oct. 1, 2021

Used for the treatment of osteoporosis.
  • Adding notification/prior authorization requirement.
  • Add Site of Care requirement
  • Prolia will be non-preferred
  • Preferred products: alendronate (generic Fosamax),* ibandronate (generic Boniva),*zoledronic acid injection (members already established on Prolia will not be required to try one of the preferred product options)

    *Coverage through pharmacy if administered orally

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 more information, please contact your broker or UnitedHealthcare representative

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.

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