The U.S. Food and Drug Administration (FDA) recently approved Radicava (edaravone), a specialty injectable medication used to treat amyotrophic lateral sclerosis (ALS). Since the medication requires infusion, Radicava will be covered on the UnitedHealthcare medical benefit with Prior Authorization review required, effective Oct. 1.
Brineura (cerliponase alfa)
The U.S. Food and Drug Administration (FDA) recently approved Brineura for the treatment of late infantile neuronal ceroid lipofuscinosis type 2 (CLN2). Since the medication requires administration directly into the brain, Brineura will be covered starting Oct, 1, 2017 on the medical benefit with Prior Authorization review required.
Soliris is currently indicated for the treatment of paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS). We already require notification/prior authorization for Soliris in an outpatient hospital setting. Beginning Oct. 1, 2017, we’ll require it in all sites of care.
The notification/Prior Authorization requirement for Radicava, Brineura, and Soliris will apply to all UnitedHealthcare commercial plans including:
UnitedHealthcare of the Mid-Atlantic
Neighborhood Health Partnership
UnitedHealthcare of the River Valley
Failure to complete the Prior Authorization process prior to the administration could result in claim denial. Health care providers cannot bill members for services that are denied for failure to complete the Prior Authorization process.
For more information, visit UnitedHealthcare’s Specialty Pharmacy Information Center or contact your UnitedHealthcare representative.