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

New specialty medical injectable updates and requirements announced May 2024.

May 28, 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

Winrevair™
(sotatercept-csrk)

Used to treat adults with pulmonary arterial hypertension.

Alyglo™
(immune globulin intravenous, human-stwk)

Used to treat adults with primary humoral immunodeficiency.

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.

Note: 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.

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Footnotes

About Chronic Diseases. Centers for Disease Control and Prevention, July 21, 2022. Available: https://www.cdc.gov/chronicdisease/about/index.htm
Ashford, K. Millennial Money: Manage the costs of a chronic condition. Nerd Wallet. April 3, 2023. Available: https://www.nerdwallet.com/article/health/medical-costs/costs-chronic-condition
Helping employees manage chronic health conditions is good for business. Employee Benefits News, Jan. 6, 2022. Available: https://www.benefitnews.com/opinion/helping-employees-manage-chronic-health-conditions-is-good-for-business
Heart Disease and Stroke. Centers for Disease Control and Prevention, Sept. 8, 2022. Available: https://www.cdc.gov/chronicdisease/resources/publications/factsheets/heart-disease-stroke.htm
Cancer. Centers for Disease Control and Prevention, June 7, 2022. Available: https://www.cdc.gov/chronicdisease/resources/publications/factsheets/cancer.htm
Diabetes and Prediabetes. Centers for Disease Control and Prevention, Sept. 6, 2022. Available: https://www.cdc.gov/chronicdisease/resources/publications/factsheets/diabetes-prediabetes.htm
Workplace Health Promotion. Centers for Disease Control and Prevention, June 9, 2022. Available: https://www.cdc.gov/chronicdisease/resources/publications/factsheets/workplace-health.htm
Optum repriced claims 2010–2018. Reconciled cases as of Feb. 2020. Accessed: April 05, 2023.

Disclaimers

Disease Management programs and services may vary on a location-by-location basis and are subject to change with written notice. UnitedHealthcare does not guarantee availability of programs in all service areas and provider participation may vary. Certain items may be excluded from coverage and other requirements or restrictions may apply. If you select a new provider or are assigned to a provider who does not participate in the Disease Management program, your participation in the program will be terminated. Self-Funded or Self-Insured Plans (ASO) covered persons may have an additional premium cost. Please check with your employer.

UnitedHealthcare Rewards is a voluntary program. The information provided under this program is for general informational purposes only and is not intended to be nor should be construed as medical advice. You should consult an appropriate health care professional before beginning any exercise program and/or to determine what may be right for you. Receiving an activity tracker, certain credits and/or rewards and/or purchasing an activity tracker with earnings may have tax implications. You should consult with an appropriate tax professional to determine if you have any tax obligations under this program, as applicable. If any fraudulent activity is detected (e.g., misrepresented physical activity), you may be suspended and/or terminated from the program. If you are unable to meet a standard related to health factor to receive a reward under this program, you might qualify for an opportunity to receive the reward by different means. You may call us toll-free at 1-855-256-8669 or at the number on your health plan ID card, and we will work with you (and, if necessary, your doctor) to find another way for you to earn the same reward. Rewards may be limited due to incentive limits under applicable law. Subject to HSA eligibility, as applicable. This program is not available in Hawaii, Kansas, Vermont and Puerto Rico. Components subject to change.

Certain preventive care items and services, including immunizations, are provided as specified by applicable law, including the Patient Protection and Affordable Care Act (ACA), with no cost-sharing to you. These services may be based on your age and other health factors. Other routine services may be covered under your plan, and some plans may require copayments, coinsurance or deductibles for these benefits. Always review your benefit plan documents to determine your specific coverage details.

The Centers of Excellence (COE) program providers and medical centers are independent contractors who render care and treatment to health plan members. The COE program does not provide direct health care services or practice medicine, and the COE providers and medical centers are solely responsible for medical judgments and related treatments. The COE program is not liable for any act or omission, including negligence, committed by any independent contracted health care professional or medical center.

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

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