Effective for dates of service on or after May 1, 2022, we’re aligning the UnitedHealthcare Oxford health plan to the existing UnitedHealthcare commercial specialty pharmacy requirement.
How this affects hospitals
We’ll continue to require participating hospitals to obtain certain specialty medications for UnitedHealthcare Oxford members from indicated specialty pharmacies, unless otherwise authorized by Oxford. If the specialty drug is obtained through the indicated specialty pharmacy, the specialty pharmacy will bill UnitedHealthcare Oxford directly for the drugs under the member’s medical benefit. Hospitals may not seek any reimbursement from the member for the medication. The drugs on the Specialty Pharmacy Requirements Drug List are subject to this requirement. At this time, the UnitedHealthcare Oxford plan will not include oncology supportive care drugs.
We anticipate the contracted specialty pharmacies will be able to supply the requested specialty medications to be administered in an outpatient hospital.
If you have questions about how this applies to your facility, please contact your network contract manager.
Please contact your provider advocate or network contract manager.