CurrentUnitedHealthcarePolicy N/A

Temporary coverage of alternative medications during drug shortages

This policy governs temporary coverage changes to Prescription Drug Lists (PDLs) across all UnitedHealthcare plans to cover therapeutic equivalent and alternative medications during FDA/ASHP-declared drug shortages. It affects providers and members whose medications are impacted by the listed shortages.

Policy Summary

PayerUnitedHealthcare

PolicyTemporary coverage of alternative medications during drug shortages

Policy CodePolicy N/A

Change TypeAdded temporary coverage for alternativesclarified reevaluation process

Effective Date

Next Review Date

Key ActionDo not submit prior authorization or step therapy for the listed alternative medications while the shortages persist.

SourceLink

POLICY UPDATE CHANGES

Temporary coverage for specified therapeutic equivalents and alternative medications during drug shortages was added.

Coverage will be reevaluated and updated when the drug shortages are no longer in effect.

No PA or step therapyauthorization requirements for alternatives

4 drugsmedications with specified alternatives

2026coverage effective dates through

Temporary Coverage During Declared Drug Shortages

Temporary coverage during declared drug shortages

Covered when ALL of the following are met

Temporary shortage-based coverage

No prior auth or step therapy: No prior authorization or step therapy is required for the listed alternative medications while the shortages are in effect.
Coverage will be reevaluated and updated when the drug shortages are no longer in effect and members/providers will be notified.

Listed alternatives and effective dates: The specific therapeutic equivalents or alternatives and their coverage effective dates are those listed by UnitedHealthcare (e.g., Vyvanse for lisdexamfetamine dimesylate effective January 1, 2024; Concerta® for methylphenidate ER effective September 1, 2024; Gastrocrom® for cromolyn sodium liquid effective April 3, 2024; Tamiflu for oseltamivir effective February 4, 2026; Climara, Minivelle, Vivelle‑Dot for estradiol patches effective March 12, 2026).

Alternatives apply only while the referenced drug shortage is in effect according to FDA or ASHP listings.

Policy Summary

PayerUnitedHealthcare

PolicyTemporary coverage of alternative medications during drug shortages

Policy CodePolicy N/A

Change TypeAdded temporary coverage for alternativesclarified reevaluation process

Effective Date

Next Review Date

Key ActionDo not submit prior authorization or step therapy for the listed alternative medications while the shortages persist.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

What Providers Need To Do / Expect

Prior Authorization

No prior authorization required

Prior authorization is not required for the alternative medications temporarily covered due to declared drug shortages. Providers do not need to submit PA requests for these listed alternatives while shortages persist.

Step Therapy

No step therapy required

Step therapy will not be required for the alternative medications temporarily covered. Providers should not be required to try preferred agents first when prescribing these alternatives during the shortage period.

Documentation Required

Documentation of authorization requirements

No prior authorization or step therapy is required for the listed alternative medications while shortages persist. Document the drug shortage and the alternative medication dispensed in the patient record as applicable.

Document shortage status and alternative chosen in chart or claim notes
Coverage is temporary and contingent on shortage declarations

Denial Risk

Temporary coverage tied to shortage status

Coverage for these alternative medications is temporary and tied to declared drug shortages (per FDA and ASHP). Requests for medications not listed as temporarily covered alternatives, or requests submitted after the related drug shortage has ended, may be denied.

Temporarily covered alternatives include (examples): Vyvanse (lisdexamfetamine dimesylate) — effective Jan 1, 2024
Concerta (methylphenidate ER, osmotic release) — effective Sep 1, 2024
Gastrocrom (cromolyn sodium liquid) — effective Apr 3, 2024
Tamiflu (oseltamivir) — effective Feb 4, 2026
Estradiol patches (Climara, Minivelle, Vivelle-Dot) — effective Mar 12, 2026

Key Terms

Therapeutic equivalent or alternative medication

DefinitionTherapeutic equivalent or alternative medication: a listed substitute product covered temporarily by UnitedHealthcare when the originally prescribed drug is in shortage per FDA or ASHP listings.

ScopeApplies to specified alternatives for drugs identified as in shortage by the U.S. Food and Drug Administration (fda.gov/drugshortages) or the American Society of Health-System Pharmacists (ashp.org/drugshortages).

Coverage durationCoverage is temporary and in effect only while the drug shortage is ongoing; coverage will be reevaluated when the shortage is resolved.

Authorization impactNo prior authorization or step therapy is required for these alternative medications while the shortages persist.

Examples listed in policyLisdexamfetamine dimesylate → Vyvanse; Methylphenidate ER (osmotic release) → Concerta®; Cromolyn sodium liquid → Gastrocrom®; Oseltamivir → Tamiflu; Estradiol patches → Climara, Minivelle, Vivelle‑Dot.

Step therapy requirement	Details
Step therapy is not required for the temporarily covered alternatives.
No prior authorization or step therapy will be required for the alternative medications temporarily covered while the shortages are in effect; coverage is temporary and will be reevaluated when shortages end.

OpenPayer

Temporary coverage of alternative medications during drug shortages

Temporary Coverage During Declared Drug Shortages

What Providers Need To Do / Expect

Key Terms

Background and Rationale

Step Therapy Requirements