Requirement updates for specialty medical injectable drugs

Specialty medical injectable drug requirements have recently changed. Please review the following tables to learn more about added drugs and updates.

Specialty medical injectable drugs added to Review at Launch Program

Drug Name UnitedHealthcare Commercial Treatment Uses
Scenesse® (afamelanotide) X Used to increase pain free light exposure in adult patients with a history of phototoxic reactions from erythropoietic protoporphyria (EPP).
Uplizna™ (inebilizumab-cdon) X For the treatment of neuromyelitis optica spectrum disorder (NMOSD).

For more information and a complete list, download the UnitedHealthcare Commercial Plan Review at Launch Medication List

 

Updates to specialty medical injectable drugs

Drug Name

Effective Date

UHC Commercial

Treatment Uses

Summary of Changes

Hereditary Angioedema (HAE) Drug Class

(Berinert®. Cinryze®, Kalbitor®, Ruconest®)

Oct. 1, 2020 X These medications are used for the treatment or prevention of hereditary angioedema (HAE).
  • Require notification/prior authorization.
  • Add clinical criteria to include a step therapy requirement through Ruconest, prior to the use of Berinert.
  • Self-administration drugs will be redirected to the Pharmacy benefit.
Krystexxa® Oct. 1, 2020 X Krystexxa is for the treatment of hyperuricemia in patients with treatment-resistant gout.
  • Require notification/prior authorization for Outpatient Hospital Place of Service.
MonoferricTM  – IV Iron Oct. 1, 2020 X

For the treatment of iron deficiency anemia in adult patients who have an intolerance to oral iron or have had unsatisfactory response to oral iron, or who have non-hemodialysis dependent chronic kidney disease.

  • Require notification/prior authorization.
  • Monoferric will be a non-preferred product. Venofer, Ferrlecit, and Infed will be the preferred IV iron products.
Drug Name

Effective Date

UHC Commercial

Treatment Uses

Summary of Changes

TepezzaTM

Oct. 1, 2020 X Tepezza is for the treatment of thyroid eye disease in adults.
  • Require notification/prior authorization.
  • Site of Care Review will be conducted.
Tysabri® Oct. 1, 2020 X Tysabri is used for the treatment of multiple sclerosis and Crohn’s disease.
  • Require notification/prior authorization for Outpatient Hospital Place of Service.
VyeptiTM Oct. 1, 2020 X

Vyepti is used for migraine prophylaxis in adults.

  • Require notification/prior authorization.
  • Site of Care Review will be conducted.

Upon prior authorization renewal, the updated policy will apply. UnitedHealthcare will honor all approved prior authorizations on file until the end date on the authorization or the date the member’s eligibility changes. Providers do not need to submit a new notification/prior authorization request for members who already have an authorization for these medications on the effective date noted above.

Note: Certain specialty medical injectable drug program updates will not be implemented for providers practicing in Rhode Island until reviewed and approved by the Rhode Island Office of Health Insurance Commissioner (OHIC).