Jun 24, 2024
Please review the following tables to determine changes to UnitedHealthcare's specialty medical injectable drug programs.
| DRUG NAME | TREATMENT USES |
|---|---|
| Beqvez™ (fidanacogene elaparvovec-dzkt) | Gene therapy used to treat adults with moderate to severe hemophilia B. |
| DRUG NAME | THERAPEUTIC CLASS | HCPCS CODE | OTHER OPTIONS |
|---|---|---|---|
| Eylea® HD (aflibercept) | Ophthalmologic VEGF inhibitors | J0177 | Avastin, Cimerli® (Lucentis biosimilar), Eylea®, Lucentis®, and Vabysmo® |
| DRUG NAME | THERAPEUTIC CLASS | HCPC CODE(S) | SPECIALTY PHARMACY |
|---|---|---|---|
| Cosentyx® IV formulation (secukinumab) | Inflammatory conditions | J3247 | Caremark (CVS Specialty) |
| Rivfloza™ (nedosiran) | Endocrine | J3490, J3590, C9399 | Caremark (CVS Specialty) |
| DRUG NAME | TREATMENT USES | SUMMARY OF CHANGES |
|---|---|---|
| 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. |
| Winrevair® (sotatercept-csrk) | Used to treat adults with pulmonary arterial hypertension. | Removed from the Review at Launch program and added to the self-administered policy due to the ability to self-administer this medication. Members will be referred to the pharmacy benefit for coverage. |
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.
