Delayed or On Hold Programs

Last update: September 16, 2020, 3:00 p.m. CDT

In response to the COVID-19 national public health emergency, UnitedHealthcare is delaying the implementation of some policy or procedure changes that were set to take effect this spring. Several recent policy or procedure changes have also been placed on temporary hold.  Please check this section often for updated information.

The following information applies to commercial pharmacy benefit plans.

Previously, we announced planned changes to coverage for some medications. However, to allow additional time for you and your patients to discuss alternative therapies when appropriate, we’re extending the effective date of coverage changes for some medications from May 1, 2020, to July 1, 2020. This means the following exclusions will now take effect on July 1, 2020:

  • Diabetes – Insulin: Basaglar® KwikPen®, Levemir®, Levemir® FlexTouch® and Tresiba®
    • These insulins are currently excluded and will be added to coverage on July 1, 2020: Lantus®, Lantus® SoloSTAR®, Toujeo® Max SoloSTAR® and Toujeo® SoloSTAR®
  • Diabetes – Non-Insulin: Janumet®, Janumet® XR and Januvia®
  • Neuromuscular Disorders: Firdapse®

In addition, step therapy for Zomig® will be required effective July 1, 2020 instead of May 1, 2020.

Additionally, we won’t be excluding the following asthma/respiratory medications at this time. These will still be covered medications until further notice: Arnuity Ellipta®, Flovent® Diskus®, Flovent® HFA and Pulmicort Flexhaler®

Since multiple prescription drug lists and benefit variations may occur, you should refer to patient-specific information received through e-prescribing or our PreCheck MyScript® tool on Link. To learn more about PreCheck MyScript, go to UHCprovider.com/pcms.

Effective April 10, 2020, OptumRx home delivery pharmacy is placing its mandatory ePrescribing policy for controlled substances (EPCS) temporarily on hold until further notice. This policy went into effect on March 1, 2020 and required care providers to send e-prescriptions for controlled substances.

During the COVID-19 national public health emergency period, OptumRx home delivery pharmacy will fill any controlled substance prescription they receive, as long as the prescription meets federal and state regulatory requirements.

Important Points

  • Any care provider or member exemption will remain on file for a year from the date it was submitted.
  • Please continue to email exemption requests to EPCSquestions@optum.com.

We’ll share updates as soon as OptumRx home delivery pharmacy determines when the EPCS requirement will resume.

The implementation date for UnitedHealthcare’s new Medicare Advantage Emergency Department (ED) Professional Evaluation & Management (E/M) Coding Policy has been delayed until Aug. 1, 2020 due to the COVID-19 national public health emergency.

The policy focuses on professional ED claims submitted with a level 5 (99285) E/M code for Medicare Advantage claims. We’ll remind care providers of the new effective date in the June Network Bulletin

Beginning Oct. 1, 2020, hospitals in UnitedHealthcare’s commercial network (Individual and Group Market health plans) will need to obtain certain specialty medications from indicated specialty pharmacies. This expansion of specialty pharmacy requirements was initially set to take effect on April 1, 2020 but was delayed to the COVID-19 national public health emergency.

The initial announcement of this expanded requirement can be found in the January 2020 issue of Network Bulletin (pages 31-37). You can also review the list of specialty pharmacy requirements. Questions?  Please contact your Network Management or Provider Relations teams.

We’re listening.

We’re committed to keeping you up to date on COVID-19 – we’re monitoring your inquiries and working hard to answer your questions. Let us know how we’re doing.

We’ll be making daily updates to this site. Be sure to check back often for the latest information. 


Disclaimer:

The benefits and processes described on this website apply pursuant to federal requirements and UnitedHealthcare national policy during the national emergency.  Additional benefits or limitations may apply in some states and under some plans during this time.

We will adjudicate benefits in accordance with the member’s health plan.

Medicaid Providers: UnitedHealthcare will reimburse out-of-network providers for COVID-19 testing-related visits and COVID-19 related treatment or services according to the rates outlined in the Medicaid Fee Schedule.