CommercialCoverageMedium impact
Oxlumo ® (Lumasiran) and Rivfloza ® (Nedosiran)
UnitedHealthcare·Nephrology, Endocrinology, Oncology +1 more·Medical Benefit Drug Policy
Effective date
Jun 1, 2026
We identified it
Jun 2, 2026
Summary
UnitedHealthcare updated the medical benefit drug policy for Oxlumo (Lumasiran) and Rivfloza (Nedosiran), two specialty medications used for rare genetic conditions. This policy update affects coverage criteria and potentially prior authorization requirements for these high-cost specialty drugs.
Action Required
By June 1, 2026: Billing team must review updated coverage criteria for Oxlumo and Rivfloza specialty medications. Update prior authorization workflows if these medications are prescribed in your practice. Verify current policy requirements before submitting claims for these specialty drugs to avoid denials.