Specialty medical injectable drug program requirements and drug policy updates: Nexviazyme®, Saphnelo™ and more

Please review the following information to determine changes to our specialty medical injectable drug programs.

SPECIALTY MEDICAL INJECTIBLE DRUGS ADDED TO REVIEW AT LAUNCH
Drug Name UnitedHealthcare Commercial Treatment Uses
Nexviazyme® X For the treatment of patients 1 year of age and older with late-onset Pompe disease.
Saphnelo™ X For the treatment of adult patients with moderate to severe systemic lupus erythematosus, who are receiving standard therapy.

View the UnitedHealthcare Commercial Plan Review at Launch Medication List.

Updates to drug prior authorization programs For UnitedHealthcare commercial business effective October 1, 2021
Drug Name Update to Program Ongoing Management

Eligard® (J9217)

Fensolvi® (J1951)

Firmagon® (J9155)

Lupron Depot® (J1950)

Supprelin® (J9226)

Trelstar® (J3315)

Triptudor® (J3316)

Vantas® (J9225)

Zoladex® (J9202)

Remove notification/prior authorization requirement for non-oncology indications.

Coverage will continue to follow the criteria within the medical benefit drug policy posted on UHCProvider.com through claim review.

Spravato® (S0013)

Sublocade® (Q9991/Q9992)

Probuphine® (J0570)

Remove notification/prior authorization requirement.
Coverage will continue to follow the criteria within the medical benefit drug policy posted on UHCProvider.com through claim review.

In an effort to streamline access to care and reduce administrative burden, UnitedHealthcare Commercial plans are modifying the Prior Authorization/Notification requirements as noted for the drugs listed above effective 10/1/2021. These changes affect UnitedHealthcare Commercial plan members, including members of affiliate plans, such as UnitedHealthcare of the Mid-Atlantic, Neighborhood Health Partnership and UnitedHealthcare of the River Valley.

Note: Certain specialty medical injectable drug 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. This exception does not apply to Medicaid and Medicare.