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 Policyopen_in_new.

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.

READ MORE 

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