Specialty medical injectable drug program, requirements and drug policy updates for October

New specialty medical injectable updates and requirements announced October 2024.

Oct. 8, 2024

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

Specialty medical injectable drugs added to review at launch
For UnitedHealthcare Commercial business

Updates to drug program requirements and drug policies
Drug Name HCPCs Code(s)
Jubbonti® (denosumab-bbdz)
Biosimilar to Prolia®		 Q5136

Ocrevus Zunovo™
(ocrelizumab and hyaluronidase-ocsq)

 J3490/J3590/C9399
Wyost® (denosumab-bbdz)
Biosimilar to Xgeva®		 Q5136

Download the UnitedHealthcare Commercial Plan Review at Launch Medication List.


Specialty medical injectable drugs added to Medical Benefit Therapeutic Equivalent Medications – Excluded Drugs
For UnitedHealthcare Commercial business

Updates to drug program requirements and drug policies
Excluded Drug Effective Date HCPCS Code(s) Other options
Alyglo™
(immune globulin intravenous, human-stwk)		 1/1/25 J1599 Bivigam® Cutaquig®, Cuvitru®, Flebogamma® DIF, Gammagard® Liquid, Gammagard® S/D, Gammaked™, Gammaplex®, Gamunex® C, Hizentra®, HyQvia®, Octagam®, Privigen® and Xembify®

Updates to drug program requirements and drug policies
for UnitedHealthcare commercial business

Updates to drug program requirements and drug policies
Drug Name Effective Date Summary of Changes
Alyglo
(immune globulin intravenous, human-stwk)		 1/1/25

In states where coverage is not excluded:

  • Add to site of care
  • Add as a non-preferred product; must step through all therapeutic equivalents prior to coverage for Alyglo
Briumvi®
(ublituximab-xiiy)
 		 1/1/25
  • Add to site of care
Cutaquig®
(Immune Globulin Subcutaneous (Human) - hipp)		 1/1/25
  • Remove from Medical Benefit Therapeutic Equivalent Medications - Excluded drugs and maintain prior authorization and site of care requirements
Kisunla™
(donanemab-azbt)		 1/1/25
  • Add prior authorization/notification
Ocrevus®
(ocrelizumab)		 1/1/25
  • Add to site of care
Ocrevus Zunovo
(ocrelizumab and hyaluronidase-ocsq)		 1/1/25
  • Add prior authorization/notification
  • Add to site of care
Tecelra®
(afamitresgene autoleucel)		 1/1/25
  • Add prior authorization/notification
  • Will be managed by Optum Transplant
Xolair®
(omalizumab)		 1/1/25
  • Add to site of care

UnitedHealthcare will honor all approved prior authorizations on file until the end date on the authorization or the date the member’s eligibility changes. Upon prior authorization renewal, the updated policy will apply.

Specialty medical injectable drugs added to Medication Sourcing for Outpatient Hospital Providers Only
for UnitedHealthcare Commercial

Updates to drug program requirements and drug policies
Summary of Changes Effective Date HCPCs Code(s) Specialty Pharmacy
Alyglo
(immune globulin intravenous, human-stwk)		 1/1/25 J1599 TBD
Kisunla
(donanemab-azbt)		 1/1/25 J0175 TBD
Ocrevus Zunovo
(ocrelizumab and hyaluronidase-ocsq)		 1/1/25 J3490/J3590/C9399 TBD

Review the UnitedHealthcare Commercial Plan Medication Sourcing List.

For questions, please contact your broker or UnitedHealthcare representative.

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