UnitedHealthcare updated its Endocrinology & Metabolism (Diabetes/Thyroid) coverage guidance with multiple annual-review edits effective 3/1/2026–5/1/2026. The CGM program explicitly adds MiniMed Instinct to the “Continuous glucose monitors, sensors and transmitters (all brands)” medical necessity policy effective 3/1/2026. Mycapssa (octreotide) criteria (effective 4/1/2026) remove prior surgery/radiation/bromocriptine requirements for initiation, add Lanreotide Injection as an example, add a prescriber requirement, clarify reauthorization with an example of positive clinical response, and note injectable somatostatin analogs may require additional benefit/coverage review. Actemra/Tyenne and Orencia wording was clarified to specify subcutaneous formulations and reinforce “not used in combination” language; Invokana was listed as non‑formulary with updated references (5/1/2026).
March–April 2026 Revision: Key Program Changes
Summary of changes in this revision
This UnitedHealthcare Commercial Business bulletin includes multiple annual reviews and specific program updates effective across two implementation dates: 3/1/2026 and 4/1/2026 (with additional entries showing 5/1/2026 for some items). Notable changes within the March 1, 2026 set include updated wording for subcutaneous formulations and "not used in combination" verbiage for agents such as Actemra (tocilizumab) and Orencia (abatacept), and an explicit addition of MiniMed Instinct to the continuous glucose monitor (CGM) program.
For the April 1, 2026 implementation group, Mycapssa (octreotide) received several substantive edits: removal of prior requirements for previous surgery, radiation, or bromocriptine for initial authorization; addition of Lanreotide Injection as an example of lanreotide; notation that injectable somatostatin analogs may be subject to additional benefit and coverage review requirements; addition of a prescriber requirement for initial authorization; clarification for reauthorization to include an example of positive clinical response; and an added exclusion footnote. These changes were recorded as part of the annual review.
Continuous Glucose Monitor Program: `MiniMed Instinct` Included
Continuous glucose monitoring programs: addition of
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