Nov 29, 2023
Please review the following tables to determine changes to UnitedHealthcare's specialty medical injectable drug programs.
| DRUG NAME | TREATMENT USES |
|---|---|
| Cosentyx® - IV Formulation (secukinumab) |
Used for the treatment of adults with active psoriatic arthritis, active ankylosing spondylitis, and active non-radiographic axial spondyloarthritis with objective signs of inflammation. |
| Pombiliti™ (cipglucosidase alfa-atga) |
Used in combination with Opfolda for the treatment of adult patients with late-onset Pompe disease weighing ≥ 40 kg and who are not improving on their current enzyme replacement therapy. |
| DRUG NAME | THERAPEUTIC CLASS | HCPC CODE(S) | SPECIALTY PHARMACY |
|---|---|---|---|
| Leqembi™ (lecanemab-irmb) |
Central Nervous System Agents | J0174 | Soleo Health |
| DRUG NAME | TREATMENT USES | SUMMARY OF CHANGES |
|---|---|---|
| Krystexxa® (pegloticase) |
Used for the treatment of chronic gout in patients refractory to conventional therapy. | Expand Notification/ Prior Authorization requirement to include all outpatient places of service – home, office, and ambulatory infusion suite in addition to outpatient hospital, which already requires prior authorization. |
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.
