Oct 14, 2024
Please review the following tables to determine changes to UnitedHealthcare's specialty medical injectable drug programs.
| DRUG NAME | TREATMENT USES | HCPCS CODE(S) |
|---|---|---|
| Jubbonti® (denosumab-bbdz) | Biosimilar to Prolia® | Q5136 |
| Ocrevus Zunovo™ (ocrelizumab and hyaluronidase-ocsq) | J3490, J3590, C9399 | |
| Wyost® (denosumab-bbdz) | Biosimilar to Xgeva® | Q5136 |
| DRUG NAME | HCPCS CODE(S) | OTHER OPTIONS |
|---|---|---|
| Alyglo™ (immune globulin intravenous, human-stwk) | J1599 | Bivigam® Cutaquig®, Cuvitru®, Flebogamma® DIF, Gammagard® Liquid, Gammagard® S/D, Gammaked™, Gammaplex®, Gamunex® C, Hizentra®, HyQvia®, Octagam®, Privigen® and Xembify® |
| DRUG NAME | SUMMARY OF CHANGES |
|---|---|
| Alyglo (immune globulin intravenous, human-stwk) | In states where coverage is not excluded:
|
| Briumvi® (ublituximab-xiiy) |
|
| Cutaquig® (Immune Globulin Subcutaneous (Human) - hipp) |
|
| Kisunla™ (donanemab-azbt) |
|
| Ocrevus® (ocrelizumab) |
|
| Ocrevus Zunovo (ocrelizumab and hyaluronidase-ocsq) |
|
| Tecelra® (afamitresgene autoleucel) |
|
| Xolair® (omalizumab) |
|
| DRUG NAME | HCPC CODE(S) | SPECIALTY PHARMACY |
|---|---|---|
| Alyglo (immune globulin intravenous, human-stwk) | J1599 | TBD |
| Kisunla (donanemab-azbt) | J0175 | TBD |
| Ocrevus Zunovo (ocrelizumab and hyaluronidase-ocsq) | J3490, J3590, C9399 | TBD |
Disclaimer: 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.
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.
