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.