United HealthCare now requires prior apporval for Acthar
UnitedHealth alerts physicians to change in authorization process for Acthar
In a network bulletin intended for health care professionals and facilities, dated January 2013, UnitedHealthcare stated that, effective April 1, 2013, the insurer will implement an "important change in the advanced notification review process for the administration of certain specialty medications covered under the medical benefit," including Questcor's (QCOR) H.P. Acthar gel. Currently it is optional for network physicians prescribing H.P. Acthar to submit for advanced notification prior to the administration of these medications, UnitedHealthcare stated. However, as of April 1, all participating network physicians will be required to submit for prior authorization review and approval prior to administration of Acthar for members with UnitedHealthcare commercial coverage plans, including those members currently on therapy. These requests may be subject to medical necessity review to determine coverage, UnitedHealthcare added. In late day trading, shares of Questcor, which had been higher for much of the session, declined 42c, or 1.57%, to $26.30.