Management strategies for Asceniv™, Cutaquig®, Evenity, Jivi®, Sodium Hyaluronate and Spravato™

Specialty medical injectable drugs added to review at launch program

Providers are recommended to request pre-service coverage reviews for medications listed on UnitedHealthcare’s Review at Launch Commercial and Community Plan Medication Lists. UnitedHealthcare added certain new drugs to the lists. See below chart for details. 

Clinical coverage reviews can also help avoid starting a patient on therapy that may later be denied due to lack of medical necessity. Claims may be denied if a pre-service coverage review is not completed.

Drug Name

Treatment Uses

Zolgensma® (onasemnogene abeparvovec-xioi)

Spinal muscular atrophy

Cutaquig® (Immune Globulin Subcutaneous - hipp)

Primary humoral immunodeficiency in patients ages 18 and older

Drugs Requiring Notification/Prior Authorization

The notification/prior authorization requirement for these medications will apply to all UnitedHealthcare commercial plans, including affiliate plans such as UnitedHealthcare of the Mid-Atlantic, UnitedHealthcare Oxford, Neighborhood Health Partnership and UnitedHealthcare of the River Valley.  

If a provider administers any of these medications without first completing the notification/prior authorization process, the claim may be denied. Members can’t be billed for services denied due to failure to complete the notification/prior authorization process. Please see below chart for details.

Drug Name

Effective Date

Treatment Uses

Summary of Changes

Asceniv™ (Immune Globulin Intravenous – slra)

Oct. 1, 2019

Used to treat primary humoral Immunodeficiency in patients ages 12 and older.

Code J1599 already requires notification/prior authorization.

Asceniv is new to market.

Cutaquig (Immune Globuline Subcutaneous – hipp)

Oct. 1, 2019

Used to treat primary humoral Immunodeficiency in adults.

Notification/prior authorization required.

Evenity (romosozumab-aqqg)

Oct. 1, 2019

Used to treat osteoporosis in patients with a high risk of fracture.

Notification/prior authorization required.

Fibryga®

July 1, 2019

Used to treat acute bleeding episodes in patients with congenital fibrinogen deficiency, including afibrinogenemia and hypo-fibrinogenemia.

 

Notification/prior authorization required.

Self-administered drug may be covered under the pharmacy benefit.

Jivi® (antihemophilic factor (recombinant) PEGylated-aucl)

Oct. 1, 2019

Used in previously treated adults and adolescents with hemophilia A for the on-demand treatment of acute bleeding episodes, perioperative management of bleeding and for the routine prophylaxis.

Notification/prior authorization required.

Self-administered drug may be covered under the pharmacy benefit.

Rebinyn®

July 1, 2019

Used to treat adults and children with hemophilia B for the on-demand treatment of acute bleeding episodes, and for the perioperative management of bleeding.

Notification/prior authorization required.

\Self-administered drug may be covered under the pharmacy benefit.

Sodium Hyaluronate Derivatives

Oct. 1, 2019

Used for treatment of pain due to osteoarthritis of the knee.

Notification/prior authorization required for the non-preferred products.

The preferred products that don't require prior authorization are: Durolane, Euflexxa and Gelsyn.

See medical policy for more information.

Spravato™ (esketamine)

Oct. 1, 2019

Used for the treatment of resistant depression.

Notification/prior authorization required.

Coverage under both medical and pharmacy benefits available.

 

Ultomiris™ (ravulizumab)

July 1, 2019

Used to treat paroxysmal nocturnal hemoglobinuria (PNH).

Notification/prior authorization required.

White Blood Cell Colony Stimulating Factors – Long Acting Products

Neulasta®,

Fulphila™,

Udenyca®

See article below

Used to treat neutropenia.

Notification/prior authorization for both cancer and non-cancer related conditions.

 

White Blood Cell Colony Stimulating Factors – short Acting Products

Granix®,

Neupogen®,

Nivestym™,

Zarxio®

Oct. 1, 2019

Used to treat neutropenia.

Notofication/prior authorization for both cancer and non-cancer related conditions.

Zolgensma (onasemnogeneabeparvovec-xioi)

Oct. 1, 2019

Used to treat spinal muscular atrophy.

Notification/prior authorization required.

Specialty drug sourcing also required.

Effective July 1, 2019, UnitedHealthcare updated its “White Blood Cell Colony Stimulating Factors” medical drug policy to include preferred product coverage criteria related to a handful of medications.

Pegfilgrastim, Neulasta Onpro® and Neulasta® are the preferred products under the medical benefit. Neulasta will be the covered product under the pharmacy benefit starting Jan. 1, 2020. For the medical drug policy, preferred product language will be added to support the prior authorization requirement as follows:

  • Use of Neulasta Onpro and Neulasta, vial prior to the coverage of Fulphila and Udenyca.

In addition to the preferred product changes to the drug policy, UnitedHealthcare commercial will expand the prior authorization/notification requirements on these medications to include use for any diagnosis.

  • Neulasta Onpro/Neulasta, Fulphila and Udenyca currently require prior authorization when used to treat a cancer diagnosis. 
  • As of July 1, 2019, UnitedHealthcare commercial plans (including affiliated plans for Oxford, UMR and Neighborhood Health Partnership) require prior authorization for use of these medications for all diagnoses. 
  • On Aug. 1, 2019, affiliate plans UnitedHealthcare of the Mid-Atlantic and UnitedHealthcare of the River Valley require prior authorization for use of these medications for all diagnoses.

Current authorizations will be honored through their end date for UnitedHealthcare commercial members. Upon authorization renewal, the updated policy will apply. Care providers are encouraged to begin using the preferred Colony Stimulating Factor products.