Certain oncology medications added to Site of Care Policy

Beginning Aug. 1, 2026, we’ll add select oncology medications, which are used in maintenance therapy or monotherapy, to our Provider Administered Drugs Site of Care Policy. The expansion of this policy is to help ensure members have access to clinically safe, quality care for injectable medications at the site of care that is most appropriate to meet their needs.  

These medications already require prior authorization for medical necessity, and the site of care review will be included in the prior authorization process. This update applies to UnitedHealthcare commercial plans, including Fully Insured, Level Funded and ASO plans.

Outpatient setting details

For individuals in the maintenance phase of cancer treatment, if the prior authorization for 1 of the in-scope medications is requested to be administered in an outpatient hospital setting, the request will be reviewed to determine whether:

• The drug is medically necessary
• The outpatient hospital setting is medically necessary

If administration in the outpatient hospital setting is not medically necessary, then once the member enters the monotherapy phase of treatment:

• We’ll authorize 2 administrations of the medication in the outpatient hospital setting to ensure there are no adverse reactions
• If adverse reactions occur, we’ll authorize continued administration in the outpatient hospital setting

If the medication was administered in combination with chemotherapy in the original regimen, and no adverse reaction occurred, then prior authorization will be given for the alternate site of care beginning with the first monotherapy infusion.