Select oncology drugs added to Site of Care Policy
AI Summary
UnitedHealthcare is adding select oncology medications used in maintenance therapy or monotherapy to their Site of Care Policy effective August 1, 2026. These medications will require prior authorization review to determine if outpatient hospital administration is medically necessary, with preference for alternate sites of care when appropriate.
Action Required
By August 1, 2026: Billing team must update prior authorization workflows for oncology maintenance/monotherapy drugs to include site of care review. Train staff on new requirements: outpatient hospital setting must be medically necessary or authorization will be given for alternate site of care. Update systems to track the 2-administration transition period for members switching from combination to monotherapy. Failure to obtain proper site of care authorization may result in claim denials.
Plan Types
Commercial
Specialties
oncology