Specialty medical injectable drug program, requirements and drug policy updates: Korsuva™, Apretude™ and more
New specialty medical injectable guidelines and requirements announced.
- Operations
- All states
Please review the following table 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 |
| Korsuva™ | x | Indicated for the treatment of moderate-to-severe pruritus associated with chronic kidney disease (CKD-aP) in adults undergoing hemodialysis (HD). |
Review the UnitedHealthcare Commercial Plan Review at Launch Medication List.
Updates to drug program requirements and drug policies for UnitedHealthcare commercial business effective July 1, 2022
| Drug Name | Treatment Uses | Summary of Changes |
| Apretude™ (cabotegravir extended-release injectable suspension) | Long-acting injectable for the treatment of pre-exposure prophylaxis (PrEP) to reduce the risk of HIV-1 infection in adolescents and adults. | Add notification/prior authorization requirement and Site of Care. Add preferred product:
|
| Botulinum toxins A and B - Dysport®, Xeomin®, Botox®, Myobloc® | Neuromuscular blocker/acetylcholine release inhibitor used in many neurological, neuromuscular, and urological conditions such as migraine, spasticity, strabismus, torticollis, urinary incontinence, and overactive bladder. | Add notification/prior authorization requirement. |
| Carvykti™ (ciltacabtagene autoleucel) | For the treatment of relapsed and/or refractory multiple myeloma after 3 or more lines of previous therapy. | Add notification/prior authorization requirement. Managed by Optum Transplant Network. |
| Leqvio® (inclisiran) | Indicated as an adjunct to diet and maximally tolerated statin therapy for the treatment of adults with heterozygous familial hypercholesterolemia (HeFH) or clinical atherosclerotic cardiovascular disease (ASCVD), who require additional lowering of low-density lipoprotein cholesterol (LDL-C). | Add notification/prior authorization requirement and Site of Care. Add preferred product:
|
| Purified Cortrophin™ Gel (repository corticotrophin) | For the treatment of Infantile Spasm or Opsoclonus Myoclonus. | Add notification/prior authorization requirement and Site of Care. |
| Vyvgart™ (efgartigimod) | For the treatment of generalized myasthenia gravis in adults who test positive for anti-acetylcholine receptor (AChR) antibody. | Add notification/prior authorization requirement and Site of Care. |
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 questions, 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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