All PlansCoverageHigh impact
Formulary updates effective Jan. 1, 2026
UPMC Health Plan·Rheumatology, Endocrinology, Orthopedics +2 more·Pharmacy
Effective date
Jan 1, 2026
We identified it
Aug 7, 2026
Summary
UnitedHealthcare formulary updates effective January 1, 2026 will impact coverage for adalimumab products, continuous glucose monitors (CGMs), and billing processes for hyaluronate intra-articular injections and select intravenous/subcutaneous products across all lines of business. The billing team must review complete policy details to identify specific code changes, coverage restrictions, and updated billing procedures before the effective date.
Action Required
Before January 1, 2026: Billing team must obtain and review the full policy details from the source URL to identify: (1) specific HCPCS codes affected by adalimumab coverage changes, (2) CGM billing codes and coverage criteria, (3) CPT/HCPCS codes for hyaluronate intra-articular injections and intravenous/subcutaneous products with new billing processes. Update billing software, encounter forms, and prior authorization workflows accordingly. Notify providers of coverage changes and new billing requirements. Claims submitted after January 1, 2026 that do not comply with updated formulary and billing requirements will be denied or subject to reconsideration.