Aug 06, 2024
Please review the following tables to determine changes to UnitedHealthcare's specialty medical injectable drug programs.
| DRUG NAME | TREATMENT USES |
|---|---|
| Wezlana™ (ustekinumab-auub) | Biosimilar for Stelara used to treat adults with moderate to severe plaque psoriasis, active psoriatic arthritis, or moderately to severely active Crohn’s disease, moderately to severely active ulcerative colitis; and pediatric patients 6 years and older with moderate to severe plaque psoriasis or active psoriatic arthritis. |
| DRUG NAME | THERAPEUTIC CLASS | HCPCS CODE | OTHER OPTIONS |
|---|---|---|---|
| Eylea® HD (aflibercept) | Ophthalmologic VEGF inhibitors | J0177 | Avastin, Cimerli® (Lucentis biosimilar), Eylea®, Lucentis®, and Vabysmo® This is a reminder; Eyelea HD strategy was initially included in the June publication. |
| DRUG NAME | THERAPEUTIC CLASS | HCPC CODE(S) | SPECIALTY PHARMACY |
|---|---|---|---|
| Beqvez™ (fidanacogene elaparvovec-dzkt) | Gene therapy | J3490, J3590, C9399 | TBD |
| DRUG NAME | THERAPEUTIC CLASS | HCPC CODE(S) | SPECIALTY PHARMACY |
|---|---|---|---|
| Eylea® HD (aflibercept) | Ophthalmologic VEGF inhibitors | J0177 | Amber Specialty Pharmacy Optum Pharmacy (Specialty) |
| DRUG NAME | TREATMENT USES | SUMMARY OF CHANGES |
|---|---|---|
| Beqvez™ (fidanacogene elaparvovec-dzkt) | Gene therapy indicated for the treatment of adults with moderate to severe hemophilia B | Add to prior authorization/notification |
| Cuvitru (immune globulin subcutaneous) | Used as replacement therapy for primary humoral immunodeficiency in adult and pediatric patients two years of age and older | Remove from Medical Benefit Therapeutic Equivalent Medications – Excluded Drugs and maintain prior authorization and Site of Care requirements |
| Eylea® HD (aflibercept) | Used to treat neovascular age-related macular degeneration, diabetic macular edema, and diabetic retinopathy. | Added prior authorization/ notification in states where coverage is not excluded. Added as a non-preferred product; members must step through therapeutic equivalent alternatives prior to coverage for Eylea® HD. This is a reminder; Eyelea HD strategy was initially included in the June publication. |
| Spevigo® SC (spesolimab-sbzo) | Used for the prevention of flare in generalized pustular psoriasis (GPP) | 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.
