Specialty medical injectable drug program, requirements and drug policy updates for December

New specialty medical injectable updates and requirements announced December 2023.

Review the following tables to determine changes to our specialty medical injectable drug programs.

SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO REVIEW AT LAUNCH

For UnitedHealthcare Commercial business

Drug Name Treatment Uses


Adzynma
(ADAMTS13, recombinant-krhn)

Enzyme replacement therapy used for the prophylactic and on-demand treatment of adult and pediatric patients with congenital thrombotic thrombocytopenic purpura.

Omvoh™ - IV formulation
(mirikizumab-mrkz)

Used for the treatment of moderately to severely active ulcerative colitis in adults.

Review the UnitedHealthcare Commercial Plan Review at Launch Medication List.

For questions, please contact your broker or UnitedHealthcare representative.


SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO MEDICATION SOURCING FOR OUTPATIENT HOSPITAL PROVIDERS ONLY

For UnitedHealthcare commercial business effective December 1, 2023

Drug Name Effective Date Therapeutic Class HCPCS Code(s) Specialty Pharmacy
Izervay™
(avacincaptad pegol)
1/1/24 Complement inhibitor – ophthalmologic use C9162 Amber Specialty Pharmacy

Review the UnitedHealthcare Commercial Plan Medication Sourcing List.

For questions, please contact your broker or UnitedHealthcare representative.

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