New Jersey – UHC Outpatient Injectable Cancer Therapy Prior Authorization Requirement

September 2019 ~

Effective October 1, an affiliate company of UnitedHealthcare (UHC), will begin managing the insurer’s prior authorization requests for outpatient injectable chemotherapy and related cancer therapies for (UHC) Community Plan members in New Jersey.

Prior Authorization for Outpatient Injectable Chemotherapy and Related Cancer Therapies

• Chemotherapy and biologic therapy injectable drugs (J9000-J9999), Leucovorin (J0640) and Levoleucovorin (J0641)
• Chemotherapy and biologic therapy injectable drugs that have a Q code
• Chemotherapy and biologic therapy injectable drugs that have not yet received an assigned code and will be billed under a miscellaneous Healthcare Common Procedure Coding System (HCPCS) code
• Colony Stimulating Factors:
• Filgrastim (Neupogen^®): J1442
• Filgrastim-aafi (Nivestym^™): Q5110
• Filgrastim-sndz (Zarxio^®): Q5101
• Pegfilgrastim (Neulasta): J2505
• Pegfilgrastim-jmdb (Fulphila): Q5108
• Sargramostim (Leukine^®): J2820
• Tbo-filgrastim (Granix^®): J1447
• Pegfilgrastim-cbqv, biosimilar (Udenyca^™): Q5111
• Denosumab (Brand names Xgeva^® and Prolia^®): J0897

According to the insurer, prior authorization will be required when adding a new injectable chemotherapy drug or cancer therapy to an existing regimen. Any active prior authorizations requested through the former process will remain in place.

Source(s): UnitedHealthcare Network Bulletin;