Specialty Pharmacy Drug List update

Last modified: May 12, 2021

Effective July 1, 2021, we’re adding the following 2 specialty medications to our Specialty Pharmacy Requirements Drug List for UnitedHealthcare commercial plans.

Amondys-45

Healthcare Common Procedure Coding System (HCPCS) codes J3490, J3590, C9399

Central Nervous System (CNS) Agents therapeutic class

OxlumoTM

HCPCS code J3490, J3590 and C9074

Endocrine therapeutic class

Please refer to this list for the specialty medications that must be obtained from an indicated specialty pharmacy.

Medication Name

Therapeutic Class

Code

Specialty Pharmacy

Amondys-45

CNS Agents

J3490

J3590

C9399

Orsini Pharmaceutical Services

 

OxlumoTM

 

Endocrine

J3490

J3590

C9074

Orsini Pharmaceutical Services

PANTHERx Rare Pharmacy

Questions? Please contact your Network Management or Provider Relations teams.

PCA-1-21-01090-VC-News