Medical Benefit Therapeutic Equivalent Medications – Excluded Drugs – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare generally excludes provider‑administered medications deemed therapeutically equivalent (those on the Medical Benefit Therapeutic Equivalent Medications — Excluded Drug List) from coverage. When a member’s benefit plan allows clinical review, approval may be granted only after review of clinical evidence and submission of medical records showing trial and failure, inadequate response, or intolerance to preferred equivalents plus a provider rationale for the excluded drug or documentation of an adverse reaction to an inactive ingredient, subject to member‑specific plan terms and applicable law.

"This Medical Benefit Drug Policy applies to certain medical benefit medications that are healthcare provider administered, that have been deemed therapeutically equivalent by the UnitedHealthcare P..."

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