Nov 06, 2023
Please review the following tables to determine changes to UnitedHealthcare's specialty medical injectable drug programs.
| DRUG NAME | TREATMENT USES |
|---|---|
| Eylea HD® (aflibercept) |
Used for the treatment of neovascular age-related macular degeneration, diabetic macular edema, and diabetic retinopathy. |
| Veopoz™ (pozelimab-bbfg) |
Used for the treatment of adult and pediatric patients, 1 year of age and older, with CHAPLE disease. |
| THERAPEUTIC CLASS | EXCLUDED MEDICATIONS | OTHER OPTIONS |
|---|---|---|
| Enzyme Replacement Therapy | Elfabrio® | Fabrazyme® |
| DRUG NAME | THERAPEUTIC CLASS | HCPC CODE(S) | SPECIALTY PHARMACY |
|---|---|---|---|
| Elevidys | Gene Therapy | J3490, J3590, C9399 | Optum Frontier Therapies |
| Vyjuvek™ | Gene Therapy | J3490, J3590, C9399 | Option Care Health |
| Roctavian® | Gene Therapy | J3490, J3590, C9399 | Contact UHC Provider Services at the number on the back of the member's ID card. |
| DRUG NAME | THERAPEUTIC CLASS | HCPC CODE(S) | SPECIALTY PHARMACY |
|---|---|---|---|
| Beovu® | VEGF | Q5124 | Accredo Health Group, Optum Pharmacy (Specialty) |
| Briumvi™ | Multiple Sclerosis | J2329 | Kroger Specialty Pharmacy, Option Care Health, Optum Pharmacy (Specialty) |
| Byooviz™ | VEGF | J0179 | Kroger Specialty Pharmacy |
| Elfabrio® (effective Jan. 1, 2024) |
Enzyme Replacement Therapy | J3490, J3590, C9399) | Eversana |
| Izervay™ (effective Jan. 1, 2024) |
Complement Inhibitors — Opthalmologic Use | J3490, J3590, C9399) | To be determined |
| Lamzede® | Enzyme Replacement Therapy | J3490, J3590, C9399 | Eversana |
| Qalsody™ | CNS Agents | J3490, J3590, C9399 | Optum Frontier Pharmacy |
| Rystiggo® (effective Jan. 1, 2024) |
Central Nervous System Agents | J3490, J3590, C9399) | PANTHERx Rare Pharmacy |
| Syfovre™ | Complement Inhibitors — Opthalmologic Use | C9151 | Optum Pharmacy (Specialty) |
| Veopoz® (effective Jan. 1, 2024) |
Blood Modifying Agents | J3490, J3590, C9399) | Orsini |
| Vyvgart® Hytrulo (effective Jan. 1, 2024) |
Central Nervous System Agents | J3490, J3590, C9399) | Option Care Health |
Note: Beovu, Byooviz, and Elfabrio will be added to Medical Benefit Therapeutic Equivalent Medications — Excluded Drugs policy for commercial members, and excluded where member benefit allows. If member benefit does not allow for exclusion, Beovu, Byooviz, and Elfabrio will require a Prior Authorization and will be subject to the Medication Sourcing Protocol.
| DRUG NAME | TREATMENT USES | SUMMARY OF CHANGES |
|---|---|---|
| Izervay™ (avacincaptag pegol) |
Used for the treatment of geographic atrophy secondary to age-related macular degeneration. | Added to medication sourcing for outpatient hospitals. |
| Roctavian™ (valoctogene roxaparvovec-rvox) |
Used for the treatment of adults with severe hemophilia A | Added to medication sourcing for all outpatient providers. |
| Rystiggo® (rozanolixizumab-noli) |
Used for the treatment of generalized myasthenia gravis in adult patients who are anti-acetylcholine receptor or anti-muscle-specific tyrosine kinase antibody positive. | Added to medication sourcing for outpatient hospitals. |
| Veopoz™ (pozelimab-bbfg) |
Used for the treatment of adult and pediatric patients, 1 year of age and older, with CHAPLE disease. | Added to review-at-launch list and medication sourcing for outpatient hospital providers. |
| Vyvgart® Hytrulo (efgartigmod alfa and hyaluronidase-qvfc) |
sed for the treatment of generalized myasthenia gravis in adult patients who are anti-acetylcholine receptor antibody positive. | Added to medication sourcing for outpatient hospitals. |
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.
Contact your Amwins Connect Regional Sales Manager for more information.
