July 01, 2022

Three drugs added to specialty pharmacy drug list for outpatient hospitals only

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.

PCA-1-22-01826-PH-News_06022022