Effective for dates of service on or after Oct. 1, 2022, we’re adding the following specialty medications to our specialty pharmacy requirements drug list for UnitedHealthcare commercial plans. This applies to outpatient hospitals only.
| HCPCS code | Medication | Therapeutic class | Specialty pharmacy |
|---|---|---|---|
| C9094 J3590 |
EnjaymoTM | Blood-modifying agents | To be announced* |
| J2998 | Ryplazim® | Rare Conditions | Nufactor, Inc. |
| J2356 | TezspireTM | Asthma | Accredo Health Group Caremark/CVS Specialty |
*We will announce the specialty pharmacies for this drug prior to Oct.1, 2022.
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.