This pharmacy bulletin outlines new or revised clinical programs and implementation dates. It’s available online for UnitedHealthcare commercial and UnitedHealthcare Oxford commercial plans.
Prior authorization and notification requirement updates
We’re making changes to certain advance notification and prior authorization requirements and are available for you in the 2021 Summary of Changes.
Reimbursement policy updates: March 2021
This month you’ll find updates for Medicaid, Medicare and Exchange plans.
Specialty Medical Injectable Drug program updates: March 2021
See the latest updates to requirements for Specialty Medical Injectable Drugs for UnitedHealthcare members.
2nd quarter prescription drug list
You can now view our commercial plan Prescription Drug List and Pharmacy Benefit Coverage Updates that will take effect May 1, 2021
Oncology supportive care medication sourcing requirement
Starting with dates of service on June 7, 2021, outpatient hospitals must obtain certain oncology supportive care medications from the participating specialty pharmacies we indicate, except as otherwise authorized by us.
Radiation therapy prior authorization update
Effective April 1, 2021, prior authorization for certain outpatient radiation therapies will be required for UnitedHealthcare commercial members. Effective April 1, 2021, prior authorization will be required for the following Radiation Therapy Services, in addition to Intensity Modulated Radiation Therapy and Proton Beam Therapy.
Radiology and Cardiology prior authorization and notification updates
Effective Jun. 1, 2021, we are updating the procedure code lists for the radiology and cardiology notification and prior authorization programs for UnitedHealthcare Community Plan, Medicare Advantage, commercial and Exchange.
Electronic Payments and Statements (EPS)
Kentucky | Massachusetts | Michigan | Missouri | Rhode Island | Washington | Wisconsin
Starting [date] we'll no longer be sending paper checks for provider payment in accordance with applicable laws.
Exchange plans: Prior authorization update
Arizona | Maryland | North Carolina | Oklahoma | Tennessee | Virginia | Washington
Effective May 1, 2021, for Exchange plans prior authorization and notification requirements will be added for the following services: breast reconstruction, congenital heart disease, durable medical equipment, genetic and molecular testing including BRCA, gender dysphoria treatment w/diagnosis, orthotics and prosthetics, Rhinoplasty and other nasal surgeries and transportation services.
Kansas: New outpatient injectable drug requirements
Effective June 1, 2021, prior authorization will be expanded for certain drugs for UnitedHealthcare Community Plan of Kansas members
Massachusetts: Prior authorization and site of service reviews
Starting June 1, 2021, for UnitedHealthcare commercial plans, we’re expanding our notification/prior authorization requirements to include certain surgical, screening colonoscopy, office and MR/CT imaging procedures.
New Jersey: New timeframe for utilization reviews
Effective June 1, 2021, for UnitedHealthcare commercial plans in New Jersey (including Oxford), the initial utilization review timeframe is changing to 72 hours for certain standard prior authorization requests, to meet state regulations (NJ HCAPP law).
New York: National Drug Code reporting
Starting June 1, 2021, an accurate National Drug Code (NDC) must be reported for all physician-administered drugs billed on the Institutional Claim form