Dec 27, 2023
Please review the following tables to determine changes to UnitedHealthcare's specialty medical injectable drug programs.
| DRUG NAME | TREATMENT USES |
|---|---|
| Adzynma (ADAMTS13, recombinant-krhn) |
Enzyme replacement therapy used for the prophylactic and on-demand treatment of adult and pediatric patients with congenital thrombotic thrombocytopenic purpura. |
| Omvoh™ - IV formulation (mirikizumab-mrkz) |
Used for the treatment of moderately to severely active ulcerative colitis in adults. |
| DRUG NAME | THERAPEUTIC CLASS | HCPC CODE(S) | SPECIALTY PHARMACY |
|---|---|---|---|
| Izervay™ (avacincaptad pegol) |
Complement inhibitor — opthalmalogic use | C9162 | Amber Specialty Pharmacy |
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.
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. Providers practicing in Rhode Island are encouraged to call in to confirm if prior authorization is required.
Contact your Amwins Connect Regional Sales Manager for more information.
