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.