United Healthcare Notification/Prior Authorization Required for New Specialty Medications

Effective Jan. 1, 2017, UnitedHealthcare requires notification for the following new specialty medications:

  • Probuphine (buprenorphine) subdermal implants are indicated for the maintenance treatment of opioid dependence in patients who have achieved and sustained prolonged clinical stability on low to moderate doses of a transmucosal buprenorphine-containing product (i.e., doses of no more than 8 mg per day of buprenorphine sublingual tablet equivalent).
  • Cinqair® (reslizumab) and Nucala® (mepolizumab) are indicated for the add-on maintenance treatment of patients with severe asthma who have an eosinophilic phenotype.
  • Ocrevus™ (ocrelizumab) is anticipated to be indicated for the treatment of primary progressive multiple sclerosis and relapsing/remitting multiple sclerosis. This drug is currently being reviewed by the U.S. Food and Drug Administration (FDA), and a decision is expected by the end of March. Prior notification will be required upon FDA approval.
  • Gonadotropin-releasing hormone analogs are indicated for the suppression of puberty in adolescents diagnosed with gender dysphoria. This new policy refers to the following GnRH Analog drug products:
    • Firmagon® (degarelix)
    • Lupron Depot® (leuprolide acetate)
    • Lupron Depot-Ped® (leuprolide acetate)
    • Supprelin® LA (histrelin acetate)
    • Trelstar® (triptorelin pamoate)
    • Vantas® (histrelin acetate)
    • Zoladex® (goserelin acetate)

For more information, visit UnitedHealthcare’s Specialty Pharmacy Information Center

DISCLOSURE

The information provided herein is intended solely for the use of our clients. You may not display, reproduce, copy, modify, license, sell or disseminate in any manner any information included herein, without the express permission of the Publisher or Publishers of articles within.

The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.