09/19/2023

United Healthcare

United Healthcare Managed Care Committee Member

Shelby Jensen, CHONC - Newland Medical Associates

General

340B Medicare Advantage Drug Pricing Program
The Health Resources and Services Administration (HRSA) 340B Drug Pricing Program gives 340B-eligible facilities access to federal resources to provide more comprehensive services to eligible patients. 

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Medicare Part B Step Therapy Programs
This policy supplements Medicare NCDs, LCDs, and manuals for the purpose of determining coverage under Medicare Part B medical benefits. This policy implements a prior authorization requirement for prescriptions or administrations of medical benefit injectables only. A member cannot be required under this policy to change a current drug/product. For the purposes of this policy, a current drug/product means the member has a paid claim for the drug/product within the past 365 days. For example, a new plan member currently using a particular drug/product will not be required to switch to the preferred drug/ product upon enrollment. Similarly, an existing member currently using a particular drug/product will not be required to change drugs/products in the event this policy is updated.

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Digital Pre-Service Appeal Submissions Required - Dec 1
Beginning Dec. 1, 2023, you’ll be required to submit medical pre-service appeals electronically. No more wasting time tracking down lost or delayed mail. See your pre-service appeal status 24/7 in the UnitedHealthcare Provider Portal.

This change affects network health care professionals (primary and ancillary) and facilities that provide services to commercial, UnitedHealthcare® Medicare Advantage, and D-SNP plan members. Although not required, we also encourage UnitedHealthcare Community Plan (Medicaid) and out-of-network health care professionals to submit pre-service appeals electronically.

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UHC Commercial 

Oncology Medication Clinical Coverage 

Roctavian™ (Valoctocogene Roxaparvovec-Rvox) 

Community Plan

Clinical Trials 

Oncology Medication Clinical Coverage 

Complement Inhibitors (Soliris® & Ultomiris®) 

Provider Administered Drugs – Site of Care 

White Blood Cell Colony Stimulating Factors 

UHC Medicare Advantage 

Genetic Testing 

Laboratory Tests and Services 

Medications/Drugs (Outpatient/Part B 

Prostate Services and Procedures and Impotence Treatment 

Radiologic Diagnostic Procedures