Commercial Business Pharmacy Update Bulletin
Bulletin listing prior authorization (UM) program type changes, additions, removals, and annual reviews for numerous commercial pharmacy products and drug classes with implementation dates (primarily 3/1/2026 through 5/1/2026). Applies to UnitedHealthcare Commercial plans; inclusion does not guarantee coverage for a particular plan.
MiniMed Instinct added to continuous glucose monitors program.
Jaythari, Kymbee, and Pyquvi (deflazacort generics) added to Emflaza program.
Nucala COPD criteria: removed chronic productive cough requirement and changed post-bronchodilator FEV1 % predicted to >=20% and <=80%.
Zepatier removed from Hepatitis C DAAs list due to market withdrawal.
Palsonify (paltusotine) new program added.
Ravicti program archived.
Onureg: added new coverage criteria for acute lymphoblastic leukemia per NCCN.
Opzelura: updated background and age recommendation for AD; combination language clarified with no change to clinical intent.
Zepbound (OSA): removed requirement for symptoms of OSA and absence of significant craniofacial abnormalities; added description of mixed and central apneas.
Aimovig/Ajovy/Emgality: updated cluster headache diagnosis criteria, pediatric adjustments for Ajovy, removed Nurtec and Qulipta as Ajovy options, added pediatric bypass.
Jascayd added to ILD agents program; Ofev criteria updated to progressive pulmonary fibrosis.
Mycapssa initial authorization criteria simplified (removed prior surgery/radiation/bromocriptine requirement) and added prescriber requirement; reauthorization criteria added example of positive response; exclusion footnote added.
Tavneos prescriber requirement updated to allow 'or in consultation with' in initial criteria.
Tibsovo AML age cutoff >=60 removed per NCCN.
Numerous new programs added with Implementation Date 5/1/2026 (examples: Palsonify earlier; Non-solid formulations additions; Myqorzo new program).
Nonnovel/annual review updates: many drugs had annual review entries with 'no changes to coverage criteria' or background/reference updates across March-May 2026.
Jaypirca coverage revised to include patients earlier in their treatment course for CLL/SLL and background and references updated.
Lenvima criteria updated based on current NCCN recommendations and references updated.
Myqorzo (aficamten) added as a new program (Notification and Medical Necessity).
Nocdurna (desmopressin acetate) program archived.
Yutrepia (treprostinil) added to PAH Agents coverage criteria and also added to list of products typically excluded from coverage.
Plans with Weight Loss/Appetite Suppression Medication Coverage updated to add Wegovy tablet and differentiate by indication.
Praluent removed ezetimibe trial requirement for primary hyperlipidemia and ASCVD; background and references updated.
Ravicti program updated to note that brand Ravicti is typically excluded from coverage.
Multiple new programs added (Redemplo plozasiran; Rhapsido remibrutinib; Wayrilz rilzabrutinib; Myqorzo aficamten; Tryvio aprocitentan; etc.).
Tryngolza (olezarsen) criteria simplified for genetic confirmation and combination use criteria added.
Wegovy injection and Wegovy tablets (Cardiovascular Risk Reduction and MASH Only) updated: removed BMI requirement in CVD reauthorization criteria and differentiated indications by formulation.
Xalkori and Zykadia background and coverage criteria updated for uterine neoplasms per NCCN.
Many products underwent annual review with no changes to coverage criteria (examples: Iwilfin, Juxtapid, Livtencity, Mytesi, Pulmozyme, Trikafta, Oxervate, Orgovyx, Orilissa, Recorlev, Rubraca, Tarpeyo, Tetrabenazine, Xospata, etc.).
Nocdurna program archived (noted above).
Rezlidhia updated to specify AML with susceptible IDH1 mutation who are not candidate for intensive induction therapy or decline, per NCCN.
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