Effective Nov. 1, 2020, Optum® Infusion Pharmacy, a UnitedHealthcare affiliate, is available to provide oncology home infusion services to UnitedHealthcare commercial members in Florida. We’re providing this option as a convenience to our members and to help limit their exposure to COVID-19.
The Oncology Home Infusion Program is available to UnitedHealthcare members in Florida with the following health plans:
To help ensure our member benefit coverage is medically appropriate, we regularly evaluate our medical policies, clinical programs and health benefits based on the latest scientific evidence and specialty society guidance. To support these goals, we require notification/prior authorization for injectable outpatient chemotherapy and related cancer therapies administered in an outpatient setting, including but not limited to intravenous, intravesical and intrathecal for a cancer diagnosis.
These prior authorization requirements apply to all benefit plans outlined in the table under Health Plan Effective Dates.
Adding a new injectable chemotherapy drug, colony stimulating factor or denosumab to a regimen will require new authorization.
Additional details regarding prior authorization requirements for radiopharmaceuticals can be found here.
To submit an online request for prior authorization, use the Prior Authorization and Notification tool on Link to submit your request. To access the tool, sign in to Link by going to UHCprovider.com and clicking on the Link button in the top right corner. Once you’re in the tool, select Oncology, and when prompted, answer the questions about the service type, member type and state.
Please complete all prior authorization requests online. The online system will identify the members who need a prior authorization request submitted.
UnitedHealthcare Community Plan Members in NY
UnitedHealthcare Community Plan Members in AZ, CA, FL, IA, LA, MD, MI, MS, NE, NJ, OH, PA, RI, TN, TX, WA and WI, and for UnitedHealthcare Commercial Plans
UnitedHealthcare Oxford Members
UnitedHealthcare uses National Comprehensive Cancer Network (NCCN) guidelines as independent recommendations for evidence-based cancer treatment.
Authorizations that follow NCCN regimens will be approved at the time of the request. We respond in three to five days to requests for pediatric chemotherapy regimens, rare cancers or chemotherapy regimens that aren’t NCCN-recommended if necessary supporting documentation is provided at the time of the request.
UnitedHealthcare benefit plans typically require prior authorization for injectable chemotherapy. The benefit plans that do require prior authorization are listed by line of business in alphabetical order UnitedHealthcare Community Plan is listed in alphabetical order and includes the state Medicaid name, if applicable.
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.
This is an expansion of our existing “Requirement to Use a Participating Specialty Pharmacy Provider for Certain Medications”, as outlined in the UnitedHealthcare Administrative Guide.
This expanded requirement applies to UnitedHealthcare commercial plans including but not limited to:
The requirement does not apply to:
For more information including FAQs, visit Specialty Pharmacy – Medical Benefit Management (Provider Administered Drugs) and click Medication Sourcing Expansion