Effective Jan. 1, 2023: Medical benefit therapeutic equivalent medications

In some cases, there are lower-cost options available for coverage when multiple medications can be used to treat the same condition for your patients. Due to the results of a clinical review and the availability of lower cost alternatives, coverage is changing for some medications. This program was implemented for our Fully Insured members on July 1, 2022, and will be expanding to participating self-funded membership on Jan. 1, 2023.

Who’s affected

These changes affect UnitedHealthcare Commercial self-funded plan members, including members of affiliate plans, such as UnitedHealthcare of the Mid-Atlantic, UnitedHealthcare Oxford and UnitedHealthcare of the River Valley.

Important points

• All approved prior authorizations for the non-covered medication will be honored until the end date on the authorization or the date the member’s eligibility changes
• This change applies whether a member is new to therapy or has already been receiving the medication
• Notification/prior authorization for the other suggested medication options listed may be required
• Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service

Excluded medications and suggested alternatives

For questions, please contact your broker or UnitedHealthcare representative.