Self-Administered Medications – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare excludes drugs that patients can self‑administer (oral, inhaled, topical, self‑injectable, etc.) from the standard medical benefit, but clinician‑administered formulations (for example IV infusions) of drugs on the Self‑Administered Medications List may be covered. Key requirements: coverage is subject to the member’s specific plan, state mandates or Medicare Advantage rules, claims must cite the Self‑Administered Medications List/HCPCS codes (use revenue code 0637 for self‑administered drugs), and documentation must demonstrate clinician administration or meet applicable medical literature/compendia and benefit‑document rules for exceptions.

"Any applicable clinician administered dosage formulations (e."

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