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

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

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

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

Medication Name HCPCs Code(s)
Encelto™
(revakinagene taroretcel-lwey)
J3490/J3590/C9399
Stoboclo®
(denosumab-bmwo)
Biosimilar to Prolia®
J3490/J3590/C9399

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

Updates to drug program requirements and drug policies
Effective Oct. 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
Encelto
(revakinagene taroretcel-lwey)

J3490/J3590/C9399

  • Add prior authorization/ notification
Nypozi™
(filgrastim-txid)
Biosimilar to Neupogen®
Q5148
  • Add prior authorization/ notification
  • Add as a non-preferred product: members must step through Nivestym™ or Zarxio™ prior to coverage for Nypozi
Qfitlia™
(fitusiran)
J3490/J3590/C9399
  • Add prior authorization/ notification
Zevaskyn™
(prademagene zamikeracel)
J3490/J3590/C9399
  • Add prior authorization/ notification
  • Will be managed by Optum Transplant

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 Oct. 1, 2025, the following specialty medical injectable medication is being added to Medication Sourcing for Outpatient Hospital Providers Only:

Medication Name HCPCs Code(s) Specialty Pharmacy 
Encelto
(revakinagene taroretcel-lwey)

J3490/J3590/C9399

Orsini Pharmaceutical Services

Review the UnitedHealthcare Commercial Plan Medication Sourcing List.

For questions, please contact your broker or UnitedHealthcare representative.

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