October 2021 policy and protocol updates overview

Your notice of protocol and policy changes from UnitedHealthcare


Appendix Bulletins

Medical policy updates: October 2021
This month, you’ll find updates for Medicaid, Medicare, Exchange and commercial plans.

Pharmacy updates
This pharmacy bulletin outlines new or revised clinical programs and implementation dates. It’s available online for UnitedHealthcare commercial and UnitedHealthcare Oxford commercial plans.

Prior authorization and notification requirement updates
We’re making changes to certain advance notification and prior authorization requirements that are available for you in the 2021 Summary of Changes.

Reimbursement policy updates: October  2021
This month, you’ll find updates for Medicaid and commercial plans.

Specialty Medical Injectable Drug program updates: October 2021
See the latest updates to requirements for Specialty Medical Injectable Drugs for UnitedHealthcare members.


Drug and pharmacy

Medicare: Changes to outpatient prior authorization process for non-oncology drugs
Effective Jan. 3, 2022, Optum, an affiliate of UnitedHealthcare, will manage prior authorization requests for non-oncology Part B medications that are covered under a UnitedHealthcare Medicare Advantage plan’s medical benefit.

Medicare: Prior authorization required for oncology anti-emetics
Effective Jan. 3, 2022, 4 anti-emetic drugs will require prior authorization for UnitedHealthcare Medicare Advantage members with a cancer diagnosis.  This change is only for members of benefit plans requiring prior authorization for outpatient injectable chemotherapy. However, this change doesn’t affect outpatient injectable chemotherapy prior authorization requirements, only requirements for anti-emetic drugs. 

Medicare: New required Part B step therapy prior authorizations
Effective for dates of service starting Jan. 3, 2022, prior authorization is required for new medications included in the UnitedHealthcare Medicare Advantage Part B step therapy program.

New York: Update to injectable cancer therapy effective date
In the July Network Bulletin, we published the New York: Injectable cancer therapy update with an effective date of Oct. 1, 2021. We’re delaying the announced transition of the prior authorization requests to Optum and the prior authorization requirements. 

Specialty pharmacy drug list update
Effective for dates of service on Jan. 1, 2022, we’re adding the following specialty medications to our specialty pharmacy requirements drug list for UnitedHealthcare commercial plans.  

Specialty Medical Injectable Drug program updates: October 2021
See the latest updates to requirements for Specialty Medical Injectable Drugs for UnitedHealthcare members.


More state and regional policy and protocol updates

2022 Individual Exchange Plans
AL,AZ,FL,GA,IL,LA,MD,MI,NC,OK,TN,TX,VA,WA
We want to share important information with you about these plans to help you prepare to care for exchange members in 2022.

Genetic and molecular testing updates
Starting Jan. 1, 2022, we’ll require prior authorization for additional genetic and molecular testing CPT® codes for our commercial plan members. 

Kentucky: Prior authorization and site of service update
We previously announced an Oct. 1, 2021, implementation date for prior authorization and site of service reviews for commercial plans in Kentucky. Please note, we’re delaying the implementation date to Jan. 1, 2022, as outlined below.

New Jersey:  2022 referral update
Starting Nov. 17, 2021, UnitedHealthcare Community Plan of New Jersey is implementing a referral process for members who need specialty care. 

Policy and protocol notices in 2022
Starting Jan 1, 2022, you will be able to find your policy and protocol updates from UnitedHealthcare under the policy and protocol updates category on UHCprovider.com/news. 

Texas Medicaid: Prior authorization changes
Effective Nov. 1, 2021, you’re required to submit a prior authorization when prescribing the attached drugs used to treat multiple sclerosis (MS) or high phosphate levels in Texas UnitedHealthcare Community Plan members. 


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