Specialty medical injectable drug program, requirements and drug policy updates for July
New specialty medical injectable updates and requirements announced June 2024.
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 |
| WezlanaTM (ustekinumab-auub) |
Biosimilar for Stelara used to treat adults with moderate to severe plaque psoriasis, active psoriatic arthritis, or moderately to severely active Crohn’s disease, moderately to severely active ulcerative colitis; and pediatric patients 6 years and older with moderate to severe plaque psoriasis or active psoriatic arthritis. |
Note: Drugs added to Review at Launch may not yet be available in the marketplace.
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 MEDICAL BENEFIT THERAPEUTIC EQUIVALENT MEDICATIONS – EXCLUDED DRUGS
For UnitedHealthcare Commercial business
| Drug Name | Effective Date | Therapeutic Class | HCPCS Code | Other Options |
| Eylea® HD (aflibercept) |
10/1/24 | Ophthalmologic VEGF inhibitors | J0177 | Avastin, Cimerli® (Lucentis biosimilar), Eylea®, Lucentis®, and Vabysmo® |
*This is a reminder; Eylea HD strategy was initially included in the June publication
SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO MEDICATION SOURCING FOR ALL OUTPATIENT PROVIDERS
For UnitedHealthcare commercial business
| Drug Name | Effective Date | Therapeutic Class | HCPCS Code | Specialty Pharmacy |
| BeqvezTM (fidanacogene elaparvovec-dzkt) |
10/1/24 | Gene therapy | J3490, J3590, C9399 | TBD |
SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO MEDICATION SOURCING FOR OUTPATIENT HOSPITAL PROVIDERS ONLY
For UnitedHealthcare commercial business
| Drug Name | Effective Date | Therapeutic Class | HCPCS Code | Specialty Pharmacy |
Eylea HD (aflibercept) |
10/1/24 | Ophthalmologic VEGF inhibitors | J0177 | Amber Specialty Pharmacy Optum Pharmacy (Specialty) |
UPDATES TO DRUG PROGRAM REQUIREMENTS AND DRUG POLICIES
For UnitedHealthcare commercial business
| Drug Name | Effective Date | Treatment Uses | Summary of Changes |
| Beqvez (fidanacogene elaparvovec-dzkt) |
10/1/2024 | Gene therapy indicated for the treatment of adults with moderate to severe hemophilia B |
Add to prior authorization/notification |
| Cuvitru (immune globulin subcutaneous) |
7/1/2024 | Used as replacement therapy for primary humoral immunodeficiency in adult and pediatric patients two years of age and older | Remove from Medical Benefit Therapeutic Equivalent Medications – Excluded Drugs and maintain prior authorization and Site of Care requirements |
| Eylea HD* (aflibercept) |
10/1/2024 | Used to treat neovascular age-related macular degeneration, diabetic macular edema, and diabetic retinopathy | Add prior authorization/ notification in states where coverage is not excluded Add as a non-preferred product; members must step through therapeutic equivalent alternatives prior to coverage for Eylea® HD |
| Spevigo® SC (spesolimab-sbzo) |
10/1/2024 | Used for the prevention of flare in generalized pustular psoriasis (GPP) | Add to Site of Care |
*This is a reminder; Eylea HD strategy was initially included in the June publication
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. Upon prior authorization renewal, the updated policy will apply.
