On April 1, UnitedHealthcare (UHC) announced updates to its Orencia policy, effective July 1, 2020. The change requires patients to fail to respond to the self-administered formulation of this drug prior to obtaining authorization for the physician-administered product.
The ACR has been in communication with UHC about this policy since October 2019, when the payer first announced changes to its policies on Orencia and other drugs with both self-administered and physician-administered formulations. UHC temporarily rescinded the policies, but has now chosen to enact the new restrictions for Orencia only.
The ACR advocated for the policies to be permanently rescinded. In the event that UHC moved forward with the policies, however, the ACR also presented an extensive list of exceptions and continued coverage for patients currently on therapy. UHC has since chosen to change the requirements for Orencia only and incorporated many of the ACR-requested exceptions, including a provision grandfathering in patients who are already on the therapy.
If you have questions regarding this policy or other insurance coverage concerns, contact [email protected].