UnitedHealthcare's Medicare Advantage Medical Policy for Medications/Drugs (Outpatient/Part B) was revised with an effective date of 2026-11-01. Eight specific drugs now require a pre-service review (Review at Launch) before they are provided: Ahzantive (aflibercept-mrbb), Enzeevu (aflibercept-abzv), Eydenzelt (aflibercept-boav), Fayuvi (rebisufligene etisparvovec-hopf), Isembyld (apitegromab-mstn), Opuviz (aflibercept-yszy), Yesafili (aflibercept-jbvf), and Zanvastro (zilganersen). The revision also clarifies that oral anti-cancer medications may be covered under a member's Part D plan rather than this policy, changes the Antigens heading to 'antigens' only, and updates the homebound definition.
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01Already effective 2026-11-01: Billing team and providers should get pre-service review before scheduling or administering Ahzantive, Enzeevu, Eydenzelt, Fayuvi, Isembyld, Opuviz, Yesafili, or Zanvastro for Medicare Advantage members, and the front desk should flag these drugs on scheduling.
02Update charge entry and claim preparation for these drugs so claims include the approved review reference.
03For oral anti-cancer medications, confirm with providers and patients whether coverage falls under the member's Part D plan.
04Review the homebound definition and update any eligibility or documentation templates that rely on it.
05Watch for the payer's next bulletin for further changes.
Original notice
Medications/Drugs (Outpatient/Part B)
uhcprovider.com · Always check the source before changing claims.
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