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.

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:

  • UnitedHealthcare
  • UnitedHealthcare of the River Valley
  • Neighborhood Health Partnership
  • All Savers
  • UnitedHealthcare of the Mid-Atlantic

The requirement does not apply to:

  • UnitedHealthcare Oxford
  • UMR
  • Harvard Pilgrim
  • Student Resources
  • UnitedHealthcare West
  • Sierra plans

UnitedHealthcare Oxford commercial plans are subject to the “Specialty Pharmacy Protocol for Certain Specialty Medications Administered in an Outpatient Hospital Setting.”

In the event the oncology supportive care medication is obtained through the specialty pharmacy we indicate:

  • The specialty pharmacy will bill UnitedHealthcare directly for the medication under the member’s medical benefit
  • The specialty pharmacy will advise the member of any medical cost-share responsibility and arrange for the collection of it
  • Hospitals may only seek reimbursement from UnitedHealthcare for administration of the medication and not for the medication itself
  • Hospitals may not seek any reimbursement from the member for the medication

We’ll announce the names and contact information for the indicated specialty pharmacies at a later date.

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