Specialty medical injectable medication program, requirement and policy updates April 2025

Review the following tables to determine changes to our specialty medical injectable medication programs and drug policy updates for April 2025.

Review at launch

The following specialty medical injectable medications have been added to Review at Launch:

Medication Name HCPCs Code(s)
Ahzantive™
(aflibercept-mrbb)
Biosimilar to Eylea®

Q5150

Bkemv™
(eculizumab-aeeb)
Biosimilar to Soliris®
Q5152
Enzeevu™
(aflibercept-abzv)
Biosimilar to Eylea
Q5149
Epysqli®
(eculizumab-aagh
Biosimilar to Soliris
Q5151

Note: Medications added to Review at Launch may not yet be available in the marketplace.

Review the UnitedHealthcare Commercial Plan Review at Launch Medication List.

For questions, please contact your broker or UnitedHealthcare representative.

Updates to drug program requirements and drug policies
Effective Jul. 1, 2025, the following drug program requirements and drug policy updates will be made to UnitedHealthcare commercial business:

 

Medication Name HCPCs Code(s) Summary of Changes
Hympavzi™
(marstacimab-hncq)
J3490/J3590/C9304
  • Add prior authorization/notification
  • Considered not medically necessary for Hemophilia A due to availability of alternate treatment options
Niktimvo™
(axatilimab-csfr)
J9038
  • Add prior authorization/notification
Ryoncil®
(remestemcel-l-rknd)

J3490/J3590/C9399

  • Add prior authorization/notification
  • Will be managed by Optum Transplant
Stelara®
(ustekinumab)
J3357, J3358
  • Will move to a non-preferred product; members must step through Steqeyma® and Yesintek™ prior to coverage
Non-preferred ustekinumab products - Biosimilars to Stelara
Otulfi™
(ustekinumab-aauz)
Q9999
  • Add prior authorization/notification
  • Add as non-preferred products; members must step through Steqeyma and Yesintek prior to coverage for a non-preferred product
  • Add to site of care
Pyzchiva®
(ustekinumab-ttwe)
Q9996, Q9997
Selarsdi™
(ustekinumab-aekn)
Q9998
Wezlana™
(ustekinumab-auub)
Q5137, Q5138

Preferred ustekinumab products - Biosimilars to Stelara

Steqeyma
(ustekinumab-stba)
J3590/C9399
  • Add prior authorization/notification
  • Add to site of care
Yesintek
(ustekinumab-kfce)
J3590/C9399

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.

Note: Certain specialty medical injectable medication 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.

Medication Sourcing for Outpatient Hospital Providers Only
Effective Jul. 1, 2025, the following specialty medical injectable medications are being added to Medication Sourcing for Outpatient Hospital Providers Only:

Medication Name HCPCs Code(s) Specialty Pharmacy
Niktimvo
(axatilimab-csfr)
J9038
TBD
Otulfi
(ustekinumab-aauz)
Biosimilar to Stelara
Q9999
TBD
Pyzchiva
(ustekinumab-ttwe)
Biosimilar to Stelara

Q9996, Q9997

TBD
Selarsdi
(ustekinumab-aekn)
Biosimilar to Stelara
Q9998
TBD
Steqeyma
(ustekinumab-stba)
Biosimilar to Stelara
J3590/C9399 TBD

Wezlana
(ustekinumab-auub)
Biosimilar to Stelara

Q5137, Q5138 TBD
Yesintek
(ustekinumab-kfce)
Biosimilar to Stelara
J3590/C9399 TBD

Review the UnitedHealthcare Commercial Plan Medication Sourcing List.

For questions, please contact your broker or UnitedHealthcare representative.

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