This pharmacy bulletin outlines new or revised clinical programs and implementation dates. It’s available online for UnitedHealthcare commercial and UnitedHealthcare Oxford commercial plans.
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UnitedHealthcare is transitioning to InterQual criteria
We will transition to InterQual criteria for all benefit plans effective May 1, 2021. We expect that using InterQual will further streamline our current clinical review processes while helping to reduce clinical decision turnaround times.
State and regional updates
New prescription safety edits
To help increase patient safety and prevent abuse and fraudulent activity, UnitedHealthcare Community Plan is continuing to implement Concurrent Drug Utilization Review (cDUR) safety edits.
Exchange plan prior authorization updates
Effective April 1, 2021, prior authorization will be required for certain stereotactic body radiation therapy and stereotactic radiosurgery services for Exchange plan members in Arizona, Maryland, North Carolina, Oklahoma, Tennessee, Virginia and Washington.
VA CCN Provider Manual updates
Routine updates will be made to the 2021 Department of Veterans Affairs (VA) Community Care Network (CCN) Provider Manual in January, April, July and October.
Effective May 1, 2021, you will need to submit prior authorization for Cinryze, Spinraza and Zolgensma for UnitedHealthcare Community Plan members in Maryland. These requirements will apply whether members are new to therapy or have already been receiving these medications
CPT® is a registered trademark of the American Medical Association.
Utah: Prior authorization letters will no longer be mailed beginning this spring
Effective May 1, 2021, we will no longer print and mail paper prior authorization letters to health care professionals in Utah. This applies to all UnitedHealthcare plans in the state. Instead, prior authorization letters will be available for viewing in Document Vault, our secure online repository of UnitedHealthcare reports and claim-related communications.