Posted in #unitedhealthcare, Pharmacy (Various Insurance Payers), Training, Updates

UHC (NY) Commercial and Community Health Pharmacy update: Xiaflex®, Riabni (rituximabarrx) for 2021

UHC Commercial Plan:

Xiaflex® Apr. 1, 2021- Treatment of Dupuytren’s contracture:

• Adding notification/prior
authorization requirement
• Adding Admin Guide
Medication Sourcing
requirement (additional
information below)

Administrative Guide Medication Sourcing Requirement for Xiaflex – Apr. 1, 2021
As a reminder, the 2021 Care Provider Administrative Guide includes information on medication sourcing requirements for in-network providers. The sourcing requirement for some specialty medications apply to all outpatient care providers (referred to as Medication Sourcing), while other sourcing requirements only apply to outpatient hospital providers (referred to as Medication Sourcing Expansion). Xiaflex will be placed under Medication Sourcing Program that applies to all outpatient care providers, effective Apr. 1, 2021. UHC have contracted specialty pharmacies for the distribution of these specialty medications. UHC participating specialty pharmacy providers give fulfillment
and distribution services to meet the needs of UHC members and UHC care providers. Effective Apr. 1, 2021, you must acquire Xiaflex from US Bioservices, unless otherwise authorized by us. The requirement does not apply when Medicare or another health benefit plan is the primary payer and UHC is the secondary payer. Contact your local UnitedHealthcare network management representative if you have any questions.

UHC Community Health:

Riabni™(rituximabarrx)Jun. 1, 2021 – Rituximab is for the treatment of several
cancer and non-cancer related conditions, including: immune thrombocytopenic purpura,
pemphigus vulgaris, Wegener’s granulomatosisrheumatoid arthritis.

• Adding notification/prior
authorization requirement
• Preferred products:
Ruxience® and Truxima®;
Rituxan®, Rituxan Hycela®
and Riabni™ will be nonpreferred.

Source: UHC March Provider News.



My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s