Complete Story
10/16/2023
United Healthcare
United Healthcare Managed Care Committee Member
Shelby Jensen, CHONC - Newland Medical Associates
General
Medical Benefit Specialty Drug Update Bulletin
Submit oral chemotherapeutic prior authorizations to CGP
Starting Nov. 1, 2023, we’ll require all prior authorizations for covered oral chemotherapeutics to be submitted using the Optum® Cancer Guidance Program (CGP). Since this change may require your office to make adjustments to your administrative process, we suggest you start submitting your prior authorization requests through the CGP today.
The option to use the CGP for oral chemotherapeutics became available in 2022 to help simplify the prior authorization process.
What is the CGP?
CGP manages prior authorization requests for oral chemotherapeutics for most members with UnitedHealthcare commercial plans and UnitedHealthcare Individual Exchange plans.* To be eligible, members must have pharmacy benefits administered by Optum Rx.
For more information, please visit our Prior authorization for oral and injectable chemotherapy and related cancer therapies page.
Questions?
If you have questions, call us at 888-397-8129, 8 a.m.-5 p.m. local time, Monday-Friday. Or, chat with a live advocate 7 a.m.-7 p.m. CT from the UnitedHealthcare Provider Portal Contact Us page.
UHC Commercial
Pharmacy and clinical updates: October 2023
UnitedHealthcare Commercial Medical Policy Update Bulletin: October 2023
UnitedHealthcare Oxford Policy Update Bulletin: October 2023
UnitedHealthcare West Benefit Interpretation Policy Update Bulletin: October 2023
UnitedHealthcare West Medical Management Guideline Update Bulletin: October 2023
Community Plan
UnitedHealthcare Community Plan Medical Policy Update Bulletin: October 2023
UnitedHealthcare Community Plan of Indiana Medical Policy Update Bulletin: October 2023
UnitedHealthcare Community Plan of Kentucky Medical Policy Update Bulletin: October 2023
UnitedHealthcare Community Plan of Louisiana Medical Policy Update Bulletin: October 2023
UnitedHealthcare Community Plan of Mississippi Medical Policy Update Bulletin: October 2023
UnitedHealthcare Community Plan of North Carolina Medical Policy Update Bulletin: October 2023
UnitedHealthcare Community Plan of Ohio Medical Policy Update Bulletin: October 2023
UnitedHealthcare Community Plan of Pennsylvania Medical Policy Update Bulletin: October 2023
UnitedHealthcare Community Plan of Tennessee Medical Policy Update Bulletin: October 2023
UHC Medicare Advantage
Medicare: Part B step therapy prior authorization requirements
Effective for dates of service starting Jan. 1, 2024, we will require prior authorization for medications included in the UnitedHealthcare® Medicare Advantage Part B step therapy program. You’ll find the latest information, including excluded plans, in the Medicare Part B Step Therapy Programs Policy.
View the list of medications included in the Part B step therapy program.
Step therapy requirements
You may need to seek prior authorization for members new to UnitedHealthcare so that we can validate prior utilization in the absence of UnitedHealthcare claims history.
Part B step therapy requirements do not apply for members who are already being treated with a non-preferred drug/product (existing utilizers) included in the Part B step therapy program. For the purposes of this program, an existing utilizer means the member has a paid claim for the drug/product within the past 365 days or has clinical documentation of current use of the non-preferred drug/product.
UnitedHealthcare Medicare Advantage Plan Reimbursement Policies Update Bulletin: October 2023
UnitedHealthcare Medicare Advantage Coverage Summary Update Bulletin: October 2023
UnitedHealthcare Medicare Advantage Policy Guideline Update Bulletin: October 2023
UnitedHealthcare Exchange Plans
UnitedHealthcare Individual Exchange Medical Policy Update Bulletin: October 2023
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