Specialty medical injectable drug program, requirements and drug policy updates
New specialty medical injectable updates and requirements announced Sept. 2023.
Review the following tables 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 |
Izervay™ (avacincaptad pegol) |
X |
Used for the treatment of geographic atrophy secondary to age-related macular degeneration. |
Review the UnitedHealthcare Commercial Plan Review at Launch Medication List.
UPDATES TO DRUG PROGRAM REQUIREMENTS AND DRUG POLICIES
For UnitedHealthcare commercial business effective November 1, 2023
| Drug Name | Treatment Uses | Summary of Changes |
Leqembi™ (lecanemab-irmb) |
Used for the treatment of Alzheimer’s disease in patients with mild cognitive impairment or mild dementia stage of disease. | Add notification/prior authorization |
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.
SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO MEDICATION SOURCING FOR OUTPATIENT HOSPITALS
For UnitedHealthcare commercial business effective December 1, 2023
| Drug Name | Therapeutic Class | HCPC Code(s) | Specialty Pharmacy |
Leqembi™ (lecanemab-irmb) |
Central Nervous System Agents |
J0174 | To be determined |
Review the UnitedHealthcare Commercial Plan Medication Sourcing List.
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