Specialty medical injectable drug program updates: Nulibry, Abecma and more

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 UnitedHealthcare Commercial Treatment Uses
Nulibry™ (fosdenopterin) X Reduce the risk of mortality in patients with molybdenum cofactor deficiency (MoCD) Type A.

View the UnitedHealthcare Commercial Plan Review at Launch Medication List.

Specialty medical injectable drugs added to review at launch for UnitedHealthcare commercial business effective July 1, 2021

Drug Name

Treatment Uses

Summary of Changes

Abecma® (Idecaptagene Cicleucel)
Car-T Cell Therapy

Adults with relapsed and refractory multiple myeloma.

  • Add notification/prior authorization requirement.
Amondys-45™ (casimersen) Duchenne muscular dystrophy (DMD) patients with mutations amenable to exon 45 skipping.
  • Add notification/prior authorization requirement.
  • Add Site of Care requirement.
Breyanzi® (lisocabtagene maraleucel)
Car-T Cell Therapy

Aggressive relapsing remitting B cell lymphoma.

  • Add notification/prior authorization requirement.
Oxlumo™ (lumasiran)

Primary hyperoxaluria type 1 (PH1) in all age groups.

  • Add notification/prior authorization.
  • Add Site of Care requirement.
Synagis® (palivizumab) Prevention of serious lower respiratory tract disease caused by respiratory syncytial virus in high-risk children.
  • Add notification/prior authorization requirement.

The updated policy will apply upon prior authorization renewal. 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.

Please contact your broker or UnitedHealthcare representative for more information.

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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