Specialty medical injectable medication program, requirement and policy updates June 2026

Review the following tables to determine changes to our specialty medical injectable medication programs and drug policy updates for June 2026.

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)
Wainua®
(eplontersen)
J3490/J3590/C9399

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.

Medical Benefit Therapeutic Equivalent Medications – Excluded Drugs
Effective September 1, 2026, the following specialty injectable medications are being added to Medical Benefit Therapeutic Equivalent Medications – Excluded Drugs for UnitedHealthcare commercial business:

Medication name HCPCs code(s) Therapeutic Class Other Options Other Options HCPCs Code(s)
Avgemsi™
(gemcitabine)

J9184

Oncology

gemcitabine J9196, J9201
Axtle™
(pemetrexed)

J9292

Oncology

pemetrexed J9294, J9297, J9305
Boruzu®
(bortezomib)

J9054

Oncology

bortezomib J9041, J9049
Cinvanti®
(aprepitant)

J0185

Anti-emetic

fosaprepitant J1453, J1456
cyclophosphamide
(Sandoz, Baxter)

J9074, J9076

Oncology

cyclophosphamide

(Auromedic, Dr. Reddy’s, not otherwise stated)

J9071, J9073, J9075
Docivyx®
(docetaxel)

J9172

Oncology

docetaxel J9171
Focinvez™
(fosaprepitant)

J1434

Anti-emetic

fosaprepitant J1453, J1456
Frindovyx™
(cyclophosphamide)

J9072

Oncology

cyclophosphamide J9071, J9073, J9075
Posfrea™
(palonosetron)

J2468

Anti-emetic

palonosetron J2469
Pemfexy®
(pemetrexed)

J9304

Oncology

pemetrexed J9294, J9297, J9305
Pemrydi RTU®
(pemetrexed)

J9324

Oncology

pemetrexed J9294, J9297, J9305

For additional information, please refer to: https://www.uhcprovider.com/en/resource-library/news/2026/oncology-drugs-site-care-policy.html

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 programs and updates may not be implemented for some providers or commercial members where prohibited by applicable state insurance mandates or regulations. Providers are encouraged to confirm whether prior authorization or other program requirements apply.

For questions, please contact your broker or UnitedHealthcare representative.

Medication Sourcing for All Outpatient Providers
Effective Jul. 1, 2026, the following specialty medical injectable medication is being added to Medication Sourcing for All Outpatient Providers for UnitedHealthcare commercial business:

Medication name HCPCs code(s) Specialty Pharmacy
Itvisma®
(onasemnogene abeparvovec-brve)
J3490/J3590/C9399 Accredo Health Group

Medication Sourcing for Outpatient Hospital Providers Only
Effective Jul. 1, 2026, the following specialty medical injectable medication is being added to Medication Sourcing for Outpatient Hospital Providers Only for UnitedHealthcare commercial business:

Medication name HCPCs code(s) Specialty Pharmacy
Avtozma®
(tocilizumab-anoh)
Biosimilar to Actemra®
Q5156 Amber Specialty Pharmacy
Caremark (CVS Specialty)

Review the UnitedHealthcare Commercial Plan Drugs that Require Sourcing List.

For questions, please contact your broker or UnitedHealthcare representative.

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