Jan 22, 2024
Please review the following tables to determine changes to UnitedHealthcare's specialty medical injectable drug programs.
| DRUG NAME | THERAPEUTIC CLASS | HCPC CODE(S) | SPECIALTY PHARMACY |
|---|---|---|---|
| Adzynma (ADAMTS13, recombinant-krhn) |
Enzyme Replacement Therapy | J3490, J3590, C9399 | TBD |
| Omvoh™-IV Formulation (mirikizumab-mrkz) |
Inflammatory Conditions | J3490, J3590, C9399 | Amber Specialty Pharmacy |
| Pombiliti™ (cipaglucosidase alfa) |
Enzyme Replacement Therapy | C9162 | Orsini Pharmaceutical Services |
| DRUG NAME | TREATMENT USES | SUMMARY OF CHANGES |
|---|---|---|
| Adzynma (ADAMTS13, recombinant-krhn) |
Used for on demand or prophylactic enzyme replacement therapy in adult and pediatric patients with congenital thrombotic thrombocytopenia purpura. | Add prior authorization/notification; add to site of care. |
| Casgevy™ (exagamglogene autotemcel) |
Gene-editing therapy for patients with severe sickle cell disease. | Add prior authorization/notification; will be managed by Optum Transplant and be given inpatient. |
| Lantidra (donislecel) |
Allogeneic pancreatic islet cellular therapy used in conjunction with concomitant immunosuppression for the treatment of adults with Type 1 diabetes who are unable to approach target HbA1c because of current repeated episodes of severe hypoglycemia despite intensive diabetes management and education. | Add prior authorization/notification; will be managed by Optum Transplant and be given inpatient. |
| Lyfgenia™ (lovotibeglogene autotemcel) |
Gene-editing therapy for patients with severe sickle cell disease. | Add prior authorization/notification; will be managed by Optum Transplant and be given inpatient. |
| Omvoh™-IV Formulation (mirikizumab-mrkz) |
Used for the treatment of moderately to severely active ulcerative colitis in adults. | Add prior authorization/notification; add to site of care. |
| Pombiliti™ (cipaglucosidase alfa) |
Used as a long-term enzyme replacement therapy in combination with Opfolda™ (covered under the pharmacy benefit) for the treatment of adults with late-onset Pompe disease who are not improving on their current enzyme replacement therapy. | Add prior authorization/notification; add to site of care; add as non-preferred product (Nexviazyme® or Lumizyme® are preferred). |
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.
