UnitedHealthcare Retools Lower-cost ARV Incentive Program

UnitedHealthcare announced last month that it would once again implement its “soft rejection” policy effective March 1 with modifications based on input from HIVMA and other provider and public health organizations. This policy is intended to encourage the use of lower cost antiretrovirals and requires patients newly prescribed Biktarvy, Genvoya or Stribild to call a specialized customer service number and opt in or out of UHC’s MyScript Rewards Program. Under the MyScript Rewards program, patients who switch to Cimduo plus either Tivicay or Isentress/Isentress HD are not subject to cost sharing and can be eligible to receive up to two $250 debit cards per year to offset other medical expenses. The MyScript Rewards program is offered only in small and large group plans and is not offered in the individual market, Medicare or Medicaid Managed Care.

UHC had agreed in December to halt implementation of this policy and reevaluate options for implementing it in response to the objections raised by HIVMA and others. With the current implementation, UHC has indicated it will provide patients and providers three months to consider enrolling in the MyScript Rewards program. At the fourth fill for Biktarvy, Genvoya or Stribild, if no action has been taken by the enrollee or their provider to opt out of the program, the enrollee or their provider will need to call a specialized customer service number and opt in or out of the MyScripts program before their prescription can be filled.

UHC’s letter regarding changes to the MyScript Rewards program to enrollees is available here and letter to providers here.  

UHC also is no longer requiring enrollees with HIV to opt-out of the specialty pharmacy program in order to fill prescriptions at the retail pharmacy and has lifted prior authorization on antiretrovirals except for Selzentry.

Finally, as of Jan. 1, UHC discontinued coverage of Atripla from its formulary, accepting no new prescriptions for Atripla and requiring all members currently using Atripla to switch to the zero cost-sharing regimens or to Tier 2 or Tier 3 options on UHC’s formulary before April 1. The removal of Atripla applies to all commercial UHC plans but does not apply to Medicaid Managed Care or Medicare coverage.