Specialty medical injectable drug program updates: Cabenuva, Remicade and more

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

SPECIALTY MEDICAL INJECTABLE DRUG ADDED TO REVIEW AT LAUNCH
Drug Name UnitedHealthcare Commercial Treatment Uses
Cabenuva® (cabotegravir and rilpivirine, injectable formulation) X A long-acting injectable formulation for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults to replace a current antiretroviral regimen in those on a stable regimen.

Download the UnitedHealthcare Commercial Plan Review at Launch Medication List here.

UPDATES TO DRUG PROGRAM REQUIREMENTS AND DRUG POLICIES
Drug Name Effective Date UHC Commercial Treatment Uses Summary of Changes
Remicade® and Infliximab biosimilars Feb. 1, 2021 X For the treatment of certain inflammatory conditions such as ankylosing spondylitis, Crohn’s disease, noninfectious uveitis, plaque psoriasis, psoriatic arthritis, rheumatoid arthritis, sarcoidosis, and ulcerative colitis.  
  • Preferred products: Inflectra® and Avsola™;  Remicade and Renflexis® will be non-preferred.
Riabni™ (rituximab-arrx) X Apr. 1, 2021 X Rituximab is for the treatment of several cancer and noncancer-related conditions, including immune thrombocytopenic purpura, pemphigus vulgaris, Wegener’s granulomatosis, rheumatoid arthritis.
  • Add notification/prior authorization requirement.
  • Preferred products: Ruxience® and Truxima®; Rituxan®, Rituxan Hycela® and Riabni™ will be non-preferred.

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. In order to help support the transition, UnitedHealthcare Commercial will be pre-loading authorizations for Inflectra and Avsola for members currently utilizing Remicade.

Footnotes

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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