Updates to coverage for certain injectable oncology drugs

Beginning Sept. 1, 2026, we’ll be updating our Medical Benefit Therapeutic Equivalent Medications – Excluded Drugs – Commercial Medical Benefit Drug Policy to exclude certain injectable oncology medications (non-preferred) when therapeutically equivalent alternatives are available. Prior authorizations will continue to be required for both non-preferred and alternative drugs.

This change is to help reduce overall health care costs for our members while still offering coverage for a drug with similar efficacy and safety as the non-preferred drug and applies to UnitedHealthcare commercial plans, fully insured and ASO, where summary plan description language allows pharmaceutical product exclusions.

Exempted members

Members may continue to get an excluded drug until current authorization expires or eligibility changes. When the current authorization expires, the provider needs to transition the member to one of the covered medications in the respective therapeutic class.

Excluded drugs

We define therapeutic equivalence as having essentially the same efficacy and adverse effect profile to another covered medication/product. The following chart lists the injectable oncology medications that will be excluded from medical benefit coverage and the approved alternative: 

How to submit and manage prior authorizations

• Sign in to the UnitedHealthcare Provider Portal with your One Healthcare ID
  • If you don’t have a One Healthcare ID, register now
• From the left-hand tabs, select Prior Authorizations & Notifications