UnitedHealthcare Updates to Specialty Medical Injectable Drug Program (November 2024)

Nov 25, 2024

Category

Please review the following tables to determine changes to UnitedHealthcare's specialty medical injectable drug programs.

**SPECIALTY MEDICAL INJECTABLE DRUGS ADDED TO** **MEDICATION SOURCING** **FOR OUTPATIENT HOSPITAL PROVIDERS ONLY**
**For UnitedHealthcare commercial business effective February 1, 2025**
DRUG NAME	HCPC CODE(S)	SPECIALTY PHARMACY
Tremfya® IV (guselkumab)	J3490/J3590/C9399, J3590, C9399	TBD

**UPDATES TO DRUG PROGRAM REQUIREMENTS AND DRUG POLICIES**
**For UnitedHealthcare commercial business effective February 1, 2025**
DRUG NAME	SUMMARY OF CHANGES
Tremfya® IV (guselkumab)	Add prior authorization/notification. Add to site of care.

UnitedHealthcare will honor all approved prior authorizations on file until the end date on the authorization or the date the member’s eligibility changes. Upon prior authorization renewal, the updated policy will apply.

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. UnitedHealthcare encourages providers practicing in Rhode Island to call in to confirm if prior authorization is required.

Contact your Amwins Connect Regional Sales Manager for more information.