Site of Care Policy Expanded to Include Additional Oncology Medications
Beginning August 01, 2026, UnitedHealthcare will expand its Provider Administered Drugs Site of Care Policy to include select oncology medications used for maintenance therapy or monotherapy. This update is intended to support access to clinically safe, high-quality injectable medication care in the most appropriate care setting based on each member’s needs.
These medications already require prior authorization to confirm medical necessity. Under the updated policy, the site of care review will become part of the existing prior authorization process. The change will apply to UnitedHealthcare commercial plans, including Fully Insured, Level Funded, and ASO plans.
Outpatient Setting Details
For members in the maintenance phase of cancer treatment, any prior authorization request for one of the included medications to be given in an outpatient hospital setting will be reviewed to confirm whether:
The medication is medically necessary.
The outpatient hospital setting is medically necessary.
If the outpatient hospital setting is not considered medically necessary, UnitedHealthcare will allow two administrations of the medication in that setting once the member begins the monotherapy phase. This is to help monitor for any possible adverse reactions.
If an adverse reaction occurs, continued administration in the outpatient hospital setting may be authorized.
If the medication was originally given along with chemotherapy and no adverse reaction occurred, prior authorization may be approved for an alternate site of care starting with the first monotherapy infusion.
Questions? Support is available.
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