Medical policy updates: July 2021
This month, you’ll find updates for Medicaid, Medicare, Exchange and commercial plans.
Prior authorization and notification requirement updates
We’re making changes to certain advance notification and prior authorization requirements and are available for you in the 2021 Summary of Changes.
Reimbursement policy updates: July 2021
This month, you’ll find updates for Medicaid and commercial plans.
Laboratory test registration requirement delayed
Due to COVID-19, we have delayed implementation of the Laboratory Test Registry protocol until further notice. This includes registration of non-genetic tests and placement of test codes on claims for non-genetic tests.
2021–2022 Preferred Lab Network expansion
We are excited to announce the new labs selected to be part of the Preferred Lab Network, effective July 1, 2021, for UnitedHealthcare Community Plan and Medicare Advantage members.
Starting Oct. 1, 2021, for UnitedHealthcare Individual Exchange plans, we’re updating the prior authorization requirements and site of service medical necessity reviews for certain surgical, office and magnetic resonance imaging (MRI)/computed tomography (CT) imaging procedures.
Update July 1, 2021: We previously announced a July 1, 2021 implementation date for prior authorization and site of service reviews for commercial plans in Massachusetts. Please note we’re delaying the implementation date to Jan. 1, 2022.
Commercial plan prescription drug list update
The Sept. 1, 2021, prescription drug list and pharmacy benefit updates for our commercial plans are now available for review.
Medicaid 3rd Quarter 2021 preferred drug list
The UnitedHealthcare Community Plan preferred drug list (PDL) is updated quarterly by our Pharmacy and Therapeutics Committee. Please review the 3rd Quarter 2021 PDL updates and update your references, as necessary.
This pharmacy bulletin outlines new or revised clinical programs and implementation dates. It’s available online for UnitedHealthcare commercial and UnitedHealthcare Oxford commercial plans.
Specialty Medical Injectable Drug program updates: July 2021
See the latest updates to requirements for Specialty Medical Injectable Drugs for UnitedHealthcare members.
Specialty Pharmacy Drug List update
Effective for dates of service beginning on Oct. 1, 2021, we’re adding the following specialty medications to our Specialty Pharmacy Requirements Drug List for UnitedHealthcare commercial plans.
New York: Injectable cancer therapy update
Effective Oct. 1, 2021, Optum will manage our prior authorization requests for outpatient injectable cancer therapies. This change applies to UnitedHealthcare Community Plan members with a cancer diagnosis in New York. Any active prior authorizations requested via the former process will remain in place.
We’re no longer sending paper checks for health care professional payment, where not prohibited by law. Instead, you’ll have 2 options for receiving payment from UnitedHealthcare: Automated Clearing House (ACH) /direct deposit online or Virtual card payment through Document Vault or mail.
Effective Oct. 7, 2021, prior authorization will be required for some outpatient radiation therapies for UnitedHealthcare Community Plan Medicaid members.