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.

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