Specialty medical injectable drug program updates: HER2-targeted monoclonal antibodies
- All States
- Fully Insured and Self-Funded
- Pharmacy
- Specialty Benefits
Specialty medical injectable drug requirements have recently changed. Please review the following table to learn more.
| Drug Name | Effective Date | UHC Commercial | Treatment Uses | Summary of Changes |
HER2-targeted monoclonal antibodies; trastuzumab products |
Feb. 1, 2021 | x | Used to treat oncology conditions as per the National Comprehensive Cancer Network (NCCN) Drugs & Biologics Compendium® | Preferred products: Kanjinti and Trazimera |
HER2-targeted monoclonal antibodies; trastuzumab/ pertuzumab combination products |
Feb. 1, 2021 | x | Used to treat oncology conditions as per the National Comprehensive Cancer Network (NCCN) Drugs & Biologics Compendium® |
Preferred products: Phesgo, Trazimera/Perjeta, and Kanjinti/Perjeta |
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 don’t 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.
Footnotes
Note: Certain specialty medical injectable drug programs and updates will not be implemented for providers practicing in Rhode Island, with respect to certain commercial members, until reviewed and approved by the Rhode Island Office of Health Insurance Commissioner (OHIC). 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.