Specialty medical injectable drug program, requirements and drug policy updates for January
Specialty medical injectable drug program, requirements and drug policy updates for January.
Review the following table to determine changes to our specialty medical injectable drug programs.
SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO MEDICATION SOURCING FOR OUTPATIENT FACILITY PROVIDERS ONLY
For UnitedHealthcare commercial business
| Drug Name | Effective Date | Therapeutic Class | HCPCS Code(s) | Specialty Pharmacy |
| Adzynma (ADAMTS13, recombinant-krhn) | 4/1/24 | Enzyme Replacement Therapy | J3490, J3590, C9399 | TBD |
| Omvoh™ - IV formulation(mirikizumab-mrkz) | 4/1/24 | Inflammatory Conditions | J3490, J3590, C9399 | Amber Specialty Pharmacy |
| Pombiliti™ (cipaglucosidase alfa) |
4/1/24 | Enzyme Replacement Therapy | C9162 | Orsini Pharmaceutical Services |
Review the UnitedHealthcare Commercial Plan Medication Sourcing List.
For questions, please contact your broker or UnitedHealthcare representative.
UPDATES TO DRUG PROGRAM REQUIREMENTS AND DRUG POLICIES
For UnitedHealthcare commercial business effective April 1, 2024
| Drug Name | Treatment Uses | Summary of Changes |
| Adzynma (ADAMTS13, recombinant-krhn) |
Used for on demand or prophylactic enzyme replacement therapy in adult and pediatric patients with congenital thrombotic thrombocytopenia purpura. | Add prior authorization/notification Add to Site of Care |
| Casgevy™ (exagamglogene autotemcel) |
Gene-editing therapy for patients with severe sickle cell disease. | Add prior authorization/notification Will be managed by Optum Transplant and be given inpatient |
| Lantidra (donislecel) |
Allogeneic pancreatic islet cellular therapy used in conjunction with concomitant immunosuppression for the treatment of adults with Type 1 diabetes who are unable to approach target HbA1c because of current repeated episodes of severe hypoglycemia despite intensive diabetes management and education. | Add prior authorization/notification Will be managed by Optum Transplant and be given inpatient |
| Lyfgenia™ (lovotibeglogene autotemcel) |
Gene-editing therapy for patients with severe sickle cell disease. | Add prior authorization/notification Will be managed by Optum Transplant and be given inpatient |
| Omvoh™ - IV formulation(mirikizumab-mrkz) | Used for the treatment of moderately to severely active ulcerative colitis in adults. | Add prior authorization/notification Add to Site of Care |
| Pombiliti™ (cipaglucosidase alfa) |
Used as a long-term enzyme replacement therapy in combination with Opfolda™ (covered under the pharmacy benefit) for the treatment of adults with late-onset Pompe disease who are not improving on their current enzyme replacement therapy. | Add prior authorization/notification Add to Site of Care Add as non-preferred product – Nexviazyme® or Lumizyme® are preferrred |
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.
For questions, please contact your broker or UnitedHealthcare representative.
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