Specialty medical injectable drug program updates: Oxlumo, Remicade, Xiaflex and more

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

Drug Name UnitedHealthcare Commercial Treatment Uses
Oxlumo™ (lumasiran) X For the treatment of primary hyperoxaluria type 1 (PH1) in all age groups.

Download the UnitedHealthcare Commercial Plan Review at Launch Medication List to learn more.*

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 These provider-administered medications are used 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.
Xiaflex® April 1, 2021 X Treatment of adult male patients with Dupuytren’s contracture or Peyronie’s disease.
  • Adding notification/prior authorization requirement.
  • Adding Admin Guide/Sourcing requirement.

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 will be pre-loading authorizations for Inflectra and Avsola for members currently utilizing Remicade.

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 and confirm if prior authorization is required. 

Effective April 1, 2021: New requirements previously communicated for the Botulinum class — Cancelled  

Provider letters were distributed beginning Dec. 18, 2020, announcing new requirements for the Botulinum class (Botox®, Dysport®, Myobloc®, and Xeomin®) – a new prior authorization and a step therapy requirement for migraine and non-migraine diagnoses. A decision was made to not implement these new requirements. 

We will provide further information regarding any new requirements for the Botulinum class in future bulletins.

Effective April 1, 2021: Updates to Drug Program requirements and policies — Rhode Island Commercial Plans only

In accordance with the Rhode Island regulation 230-RICR-20-30-14, new drug program requirements will be effective for providers practicing in Rhode Island. For more information on the new Rhode Island requirements, review the January 2021 Network Bulletin for the full list.

For more information, please contact your broker or UnitedHealthcare representative.

*Review at launch medication list can be accessed by following the following path: Go to UHCprovider.com > Policies and Protocols > Commercial Policies > Medical & Drug Policies and Coverage Determination Guidelines for UnitedHealthcare Commercial Plans > Review at Launch for New to Market Medications > Review at Launch Medication List.

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