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.
HCPCS code |
Medication |
Therapeutic class |
Specialty pharmacy |
|
J3490 J3590 C9399 |
Nexviazyme™ |
Enzyme replacement therapy |
Orsini Pharmaceutical Services |
|
J3490 J3590 C9399 |
Saphnelo™ |
Immune modulator |
US Bioservices |
|
The planned Jan. 1 addition of Ryplazim® is postponed and the new date for including in the drug list is to be determined.
Specialty pharmacy requirement
Outpatient hospitals are required to obtain the medications listed above from the indicated specialty pharmacies for administration of these medications, unless otherwise authorized by us. In the event the specialty medication is obtained through the specialty pharmacy, the specialty pharmacy will bill us directly for these medications under the member’s medical benefit.
Questions? Please contact your Network Management or Provider Relations teams.