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UnitedHealthcare Updates to Specialty Medical Injectable Drug Program

Nov 06, 2023
Category
Carrier News

Please review the following tables to determine changes to UnitedHealthcare's specialty medical injectable drug programs.

 

SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO THE REVIEW AT LAUNCH MEDICATION LIST
DRUG NAME TREATMENT USES
Eylea HD®
(aflibercept)
Used for the treatment of neovascular age-related macular degeneration, diabetic macular edema, and diabetic retinopathy.
Veopoz™
(
pozelimab-bbfg)
Used for the treatment of adult and pediatric patients, 1 year of age and older, with CHAPLE disease.

 

SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO MEDICAL BENEFIT THERAPEUTIC EQUIVALENT MEDICATIONS – EXCLUDED DRUGS
For UnitedHealthcare commercial business effective January 1, 2024
THERAPEUTIC CLASS EXCLUDED MEDICATIONS OTHER OPTIONS
Enzyme Replacement Therapy Elfabrio® Fabrazyme®

 

SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO MEDICATION SOURCING FOR ALL OUTPATIENT PROVIDERS
For UnitedHealthcare commercial business effective October 1, 2023
DRUG NAME THERAPEUTIC CLASS HCPC CODE(S) SPECIALTY PHARMACY
Elevidys Gene Therapy J3490, J3590, C9399 Optum Frontier Therapies
Vyjuvek™ Gene Therapy J3490, J3590, C9399 Option Care Health
Roctavian® Gene Therapy J3490, J3590, C9399 Contact UHC Provider Services at the number on the back of the member's ID card.

 

SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO MEDICATION SOURCING FOR OUTPATIENT HOSPITAL PROVIDERS ONLY
For UnitedHealthcare commercial business effective October 1, 2023
DRUG NAME THERAPEUTIC CLASS HCPC CODE(S) SPECIALTY PHARMACY
Beovu® VEGF Q5124 Accredo Health Group, Optum Pharmacy (Specialty)
Briumvi™ Multiple Sclerosis J2329 Kroger Specialty Pharmacy, Option Care Health, Optum Pharmacy (Specialty)
Byooviz™ VEGF J0179 Kroger Specialty Pharmacy
Elfabrio®
(effective Jan. 1, 2024)
Enzyme Replacement Therapy J3490, J3590, C9399) Eversana
Izervay™
(effective Jan. 1, 2024)
Complement Inhibitors — Opthalmologic Use J3490, J3590, C9399) To be determined
Lamzede® Enzyme Replacement Therapy J3490, J3590, C9399 Eversana
Qalsody™ CNS Agents J3490, J3590, C9399 Optum Frontier Pharmacy
Rystiggo®
(effective Jan. 1, 2024)
Central Nervous System Agents J3490, J3590, C9399) PANTHERx Rare Pharmacy
Syfovre™ Complement Inhibitors — Opthalmologic Use C9151 Optum Pharmacy (Specialty)
Veopoz®
(effective Jan. 1, 2024)
Blood Modifying Agents J3490, J3590, C9399) Orsini
Vyvgart® Hytrulo
(effective Jan. 1, 2024)
Central Nervous System Agents J3490, J3590, C9399) Option Care Health

Note: Beovu, Byooviz, and Elfabrio will be added to Medical Benefit Therapeutic Equivalent Medications — Excluded Drugs policy for commercial members, and excluded where member benefit allows. If member benefit does not allow for exclusion, Beovu, Byooviz, and Elfabrio will require a Prior Authorization and will be subject to the Medication Sourcing Protocol.

UPDATES TO DRUG PROGRAM REQUIREMENTS AND DRUG POLICIES
For UnitedHealthcare commercial business effective October 1, 2023
DRUG NAME TREATMENT USES SUMMARY OF CHANGES
Izervay™
(avacincaptag pegol)
Used for the treatment of geographic atrophy secondary to age-related macular degeneration. Added to medication sourcing for outpatient hospitals.
Roctavian™
(valoctogene roxaparvovec-rvox)
Used for the treatment of adults with severe hemophilia A Added to medication sourcing for all outpatient providers.
Rystiggo®
(rozanolixizumab-noli)
Used for the treatment of generalized myasthenia gravis in adult patients who are anti-acetylcholine receptor or anti-muscle-specific tyrosine kinase antibody positive. Added to medication sourcing for outpatient hospitals.
Veopoz™
(pozelimab-bbfg)
Used for the treatment of adult and pediatric patients, 1 year of age and older, with CHAPLE disease. Added to review-at-launch list and medication sourcing for outpatient hospital providers.
Vyvgart® Hytrulo
(efgartigmod alfa and hyaluronidase-qvfc)
sed for the treatment of generalized myasthenia gravis in adult patients who are anti-acetylcholine receptor antibody positive. Added to medication sourcing for outpatient hospitals.

 

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.

Contact your Amwins Connect Regional Sales Manager for more information.

 

Tags
UnitedHealthcare

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