Apr 30, 2024
Please review the following tables to determine changes to UnitedHealthcare's specialty medical injectable drug programs.
| DRUG NAME | TREATMENT USES |
|---|---|
| Tofidence™ (tocilizumab-bavi) |
Biosimilar for Actemra indicated for the treatment of rheumatoid arthritis, polyarticular juvenile idiopathic arthritis, and systemic juvenile idiopathic arthritis. |
| Tyenne® (tocilizumab-aazg) |
Biosimilar for Actemra indicated for the treatment of rheumatoid arthritis, giant cell arteritis, polyarticular juvenile idiopathic arthritis, and systemic juvenile idiopathic arthritis. |
| Tyruko® (natalizumab-sztn) |
Biosimilar for Tysabri indicated for the treatment of multiple sclerosis and Crohn’s disease. |
| DRUG NAME | THERAPEUTIC CLASS | HCPC CODE(S) | SPECIALTY PHARMACY |
|---|---|---|---|
| Cosentyx® IV (secukinumab) |
Inflammatory Conditions | J3490, J3590, C9399 | To Be Determined |
| Rivfloza™ (nedosiran) |
Enzyme Replacement Therapy | J3490, J3590, C9399 | To Be Determined |
| DRUG NAME | TREATMENT USES | SUMMARY OF CHANGES |
|---|---|---|
| Amtagvi™ (lifileucel) |
Tumor infiltrating lymphocyte therapy used to treat advanced melanoma. | Add prior authorization/ notification Will be managed by Optum Transplant and given inpatient |
| Cosentyx® IV (secukinumab) |
Used for the treatment of patients with psoriatic arthritis, ankylosing spondylitis, or axial spondyloarthritis. | Add prior authorization/ notification Add to Site of Care Add as non-preferred product; Cosentyx® SC is preferred |
| Lenmeldy™ (atidarsagene autotemcel) |
Gene therapy used to treat children with early-onset metachromatic leukodystrophy. | Add prior authorization/ notification Will be managed by Optum Transplant |
| Rivfloza™ (nedosiran) |
Used to lower urinary oxalate levels in children 9 years of age and older and adults with primary hyperoxaluria type 1 and relatively preserved kidney function. | Add prior authorization/ notification Add to Site of Care |
Disclaimer: 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.
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.
