Florida Outpatient Injectable Chemotherapy Notification for UHC MA Plans

December 2017 ~

On March 1^st, 2018, UnitedHealthcare (UHC) will require notification for injectable outpatient chemotherapy drugs given for a cancer diagnosis for UHC Medicare Advantage health plan members in Florida and Georgia, including AARP MedicareComplete, Care Improvement Plus, UHC Dual Complete^® and UHC Group Medicare plans.

As of March 1^st, notification will be required for:

• Chemotherapy injectable drugs (J9000 – J9999), Leucovorin (J0640) and Levoleucovorin (J0641)
• Chemotherapy injectable drugs that have a Q code
• Chemotherapy injectable drugs that haven’t received an assigned code and will be billed under a miscellaneous Healthcare Common Procedure Coding System (HCPCS) code
• All outpatient injectable chemotherapy drugs and growth factors started after the notification effective date
• Adding a new injectable chemotherapy drug or growth factor to a regimen

Notification will not be required for:

• Radio-therapeutic agents (e.g., Zevalin and Xofigo)
• Oral chemotherapy drugs, which are covered under a member’s pharmacy benefit plan
• Growth factors including: J2505 (Neulasta), J1442, (Neupogen), J2820 Leukine^® (Sargramostim), Q5101, (Filgrastim–biosimilar Zarxio), J1447 Granix (Tbofilgrastim)
• Use of chemotherapy drugs for non-cancer diagnosis

Source(s): UnitedHealthcare Network Bulletin;