Beginning Jan. 1, 2017, United Healthcare (UHC) placed commonly prescribed AHF in higher tiered categories on their prescription formulary.
Individual plans vary, but some factor products may only be available at a higher co-pay for patients, some may require a prior authorization process which includes a SOMN documenting failure of another product, and some products are excluded altogether.
|Products||1/1/2017 Tier||What it Means|
|Kogenate FS, Kovaltry, Novoeight, Nuwig||Tier 2 (preferred)||No prior authorization required, typical co-pay $20-40|
|Eloctate||Tier 3||Prior authorization required, typical co-pay $40-75|
|Advate, Recombinate||Tier 3/4||Prior authorization required (unless previously using this product), typical co-pay $40-75/additional co-insurance may apply.|
|Adynovate, Helixate FS||Excluded||Not covered by UHC plans|
If you have patients with UHC benefits, please be aware that these formulary changes could affect their out-of-pocket costs. Manufacturer co-pay assistance programs are still available for most products and may help alleviate the increase.
For more information please call Tanya Saenz or Jason Andre at (949) 223-9828.