UnitedHealthcare (UHC) is rescinding changes to its Orencia policy previously scheduled to go into effect July 1, 2020. These changes would have required patients to fail to respond to the self-administered formulation of the drug prior to obtaining authorization for the physician-administered product.
Some patients on Orencia received notices from UHC in late April stating they would need prior authorization to continue therapy after July 1. These notices should be disregarded as the policy changes will no longer be implemented. An updated letter is being sent to patients confirming this change.
The ACR has been in communication with UHC about this policy since October 2019, when the payer first announced its intent to change its policies on drugs with both self-administered and physician-administered formulations. The ACR has continually advocated for access to medically appropriate therapies and continued coverage for patients already receiving treatment. We are pleased with UHC’s decision to rescind the change, especially during a public health emergency when these changes would have added to the challenges already facing practices and patients.
If you have questions regarding this policy or other insurance coverage concerns, contact [email protected].
