Commercial Business Pharmacy Update Bulletin
A UnitedHealthcare Commercial Business pharmacy update bulletin listing programs (notification, medical necessity, step therapy, non-formulary) and summary changes for many drugs and therapeutic classes, with implementation dates (primarily 3/1/2026, 4/1/2026, 5/1/2026). Applies to prior authorization/UM program updates; inclusion does not guarantee coverage by any specific plan.
Nucala COPD post-bronchodilator FEV1 % predicted criterion changed from '>=30% and <=70%' to '>=20% and <=80%'.
Hepatitis C DAAs: Zepatier removed from program due to market withdrawal.
Added MiniMed Instinct to continuous glucose monitors program.
Added new programs and program inclusions (examples: Palsonify, Tonmya, Dawnzera, Forzinity, Komzifti, Kygevvi, Hyrnuo, Myqorzo, Voyxact).
Zepbound (tirzepatide) OSA criteria: removed symptom requirement and craniofacial exclusion; added mixed and central apnea description.
Xeljanz PsA criteria updated to include Oral Solution formulation for pediatric indication (>=2 years).
Aimovig/Ajovy/Emgality criteria updated with pediatric info and removal of specific alternative options for Ajovy; pediatric bypass added.
Mycapssa initial authorization criteria changed: removed prior surgery/radiation/bromocriptine requirements; added lanreotide example and prescriber requirement; reauthorization now includes example of positive clinical response; added exclusion footnote.
Interstitial lung disease agents updated: added Jascayd and coverage criteria for progressive pulmonary fibrosis; Ofev moved to progressive pulmonary fibrosis section and chronic fibrosing ILD with progressive phenotype removed.
Brexafemme: removed 7-day fluconazole trial requirement for vulvovaginal candidiasis per CDC guidance.
Addyi FDA approval update to women ages <=65 reflected in coverage/program update.
Jaypirca coverage revised to include patients earlier in their treatment course for CLL/SLL per updated labeled indication.
Lenvima criteria updated based on current NCCN recommendations.
Yutrepia (treprostinil) added to PAH Agents coverage criteria and to the list of products typically excluded from coverage.
Wegovy tablet formulation added and differentiated by indication; CVD reauthorization criteria updated to remove BMI requirement.
Praluent policy removed ezetimibe trial requirement for primary hyperlipidemia and ASCVD.
Tryngolza genetic confirmation criteria simplified and combination use criteria added.
Multiple new programs added (Myqorzo, Redemplo, Rhapsido, Wayrilz, Tryvio listed as new programs or new UM types).
Rezildhia (olutasidenib) updated to specify AML with susceptible IDH1 mutation for patients not candidates for intensive induction therapy or who decline per NCCN.
Nocdurna program archived.
Ravicti program updated to note that brand Ravicti is typically excluded from coverage.
Oxervate annual review with no change to clinical criteria.
Trikafta annual review; no changes to coverage criteria.
Multiple products received annual reviews with either no changes to coverage criteria or updated background/references.
PAH Agents list expanded to explicitly enumerate included products and to add Yutrepia.
Rubraca background updated based on updated FDA label.
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.