Released on Feb 4, 2021

What you need to know about UnitedHealthcare’s Remicade coverage change

Effective February 1, 2021, United enacted a policy to remove Remicade as a preferred product as announced in its Medical benefit specialty drug update bulletin. However, United has made clear that patients will not be required to switch until the date of their prior authorization renewal. As per its policy, “UnitedHealthcare will honor all approved prior authorizations on file until the end date on the authorization or the date the member’s eligibility changes. Providers don’t need to submit a new notification/prior authorization request for members who already have an authorization…”

After conversations with our societies’ physician experts, United agreed to modify its coverage policy to allow pediatric patients 16 years of age and younger and currently on Remicade to remain on Remicade if that is the recommendation of the treating physician.

Adult patients meeting the following conditions may be allowed to remain on Remicade, but will require the prescribing provider to request a review and a determination will be made on a case-by-case basis:

  • Adult patients currently on induction of Remicade for less than 18 months will not be required to switch.
  • Adult patients who are having a flare of active disease, and hence are not stable, will not be required to switch.

United shared it is educating all of its medical directors as quickly as possible about these changes and will develop new member education to more clearly communicate the new policy to patients, many of whom were confused by wording of the original notice.

Please contact your specialty society staff if you are encountering problems with the prior authorization process, your patient was switched without your consent or your request to keep your patient who meets the above criteria on Remicade has been denied. United has asked us to report any problems so it can continue to refine its communications and efforts as needed.


ACG
Brad Conway
bconway@gi.org

AGA
Leslie Narramore
Lnarramore@gastro.org

ASGE
Lakitia Mayo
lmayo@asge.org

NASPGHAN
Camille Bonta
cbonta@summithealthconsulting.com


About Gastrointestinal Endoscopy
Gastrointestinal endoscopic procedures allow the gastroenterologist to visually inspect the upper gastrointestinal tract (esophagus, stomach and duodenum) and the lower bowel (colon and rectum) through an endoscope, a thin, flexible device with a lighted end and a powerful lens system. Endoscopy has been a major advance in the treatment of gastrointestinal diseases. For example, the use of endoscopes allows the detection of ulcers, cancers, polyps and sites of internal bleeding. Through endoscopy, tissue samples (biopsies) may be obtained, areas of blockage can be opened and active bleeding can be stopped. Polyps in the colon can be removed, which has been shown to prevent colon cancer.

About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal endoscopy. ASGE, with more than 15,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit www.asge.org and www.screen4coloncancer.org for more information and to find a qualified doctor in your area.

 

American Society for Gastrointestinal Endoscopy
3300 Woodcreek Drive Downers Grove, IL 60515
P (630) 573-0600
F (630) 963-8332
 www.asge.org
 www.screen4coloncancer.org

Media Contact

Andrea Lee
Director of Marketing and Communications
630.570.5603
ALee@asge.org