Specialty pharmacy drug list update

Effective for dates of service beginning on Dec. 1, 2021, we’re adding the following specialty medications to our specialty pharmacy requirements drug list for UnitedHealthcare commercial plans. The addition of this drug had been previously scheduled for Oct. 1, 2021. 

The full specialty pharmacy requirements drug list, including the commercial plans that are excluded from the requirement, can be found here

HCPCS code Medication Therapeutic class Specialty pharmacy
J3490
J3590
C9399
Nulibry Enzyme replacement therapy US Bioservices

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.

PCA-1-21-03804-PH-News