Medication Sourcing drug list updates
Updated specialty pharmacy requirement includes 3 new specialty drugs and 1 new complex and rare disease drug.
Effective for dates of service on or after April 1, 2023, we’re adding the following specialty medications to the specialty pharmacy requirements drug list for UnitedHealthcare commercial plans. This applies to outpatient hospitals only for specialty and oncology supportive care drugs and to all outpatient places of service for certain complex and rare disease drugs.
| Medication name | Therapeutic class | Code | Specialty pharmacy |
|---|---|---|---|
| Xenpozyme™* | Enzyme replacement therapy | J3490 J3590 C9399 |
Kroger Specialty Pharmacy Option Care Health |
| Spevigo®* | Inflammatory conditions | J3490 J3590 C9399 |
To be determined |
| Tzield™* | Immune modulator | J3490 J3590 C9399 |
To be determined |
| Hemgenix** | Cellular therapy | J3490 J3590 C9399 |
To be determined |
*Specialty or oncology supportive care drug (outpatient hospital only)
**Complex & rare disease drug (all outpatient places of service)
We’ll announce the specialty pharmacies that will supply these drugs prior to April 1, 2023.
Specialty pharmacy requirement
Providers are required to obtain the medications linked above from the indicated specialty pharmacies, unless otherwise authorized by us. When 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. The facility administering the specialty drug is not to bill us for the medication obtained through the specialty pharmacy.
Questions?
Please contact your Network Management or Provider Relations teams.
