Mar 25, 2024
Please review the following tables to determine changes to UnitedHealthcare's specialty medical injectable drug programs.
| DRUG NAME | TREATMENT USES |
|---|---|
| Rivfloza™ (nedosiran sodium) |
Used to lower urinary oxalate levels in children 9 and older and adults with primary hyperoxaluria type 1 and relatively preserved kidney function. |
| DRUG NAME | THERAPEUTIC CLASS | HCPC CODE(S) | SPECIALTY PHARMACY |
|---|---|---|---|
| Adzynma (ADAMTS13, recombinant-krhn) |
Enzyme Replacement Therapy | J3490, J3590, C9399 | Orsini Pharmaceutical Services |
| DRUG NAME | TREATMENT USES | SUMMARY OF CHANGES |
|---|---|---|
| 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. Add as non-preferred product – must try and fail two of the following prior to coverage for Omvoh IV: Simponi®, Stelara®, Xeljanz®, Rinvoq® |
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.
