United Healthcare Managed Care Committee Member
Shelby Jensen, CHONC - Newland Medical Associates
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.
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.
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.
Oncology Medication Clinical Coverage
Roctavian™ (Valoctocogene Roxaparvovec-Rvox)
Oncology Medication Clinical Coverage
Complement Inhibitors (Soliris® & Ultomiris®)
Provider Administered Drugs – Site of Care
White Blood Cell Colony Stimulating Factors
Medications/Drugs (Outpatient/Part B
Prostate Services and Procedures and Impotence Treatment
Radiologic Diagnostic Procedures