UnitedHealthcare maintains 594 commercial drug prior authorization policies—nearly twice what I found at Highmark.
- 22 re-posted in the last 30 days
- 62 posted in the last 60 days
- November 2025 alone: 87 policy re-postings across 4 batch dates
But here’s what’s different: UHC runs a refreshing cadence every month. Look at their batch update pattern from 2025:
| Date | Policies Updated |
| Jul 15 | 52 |
| Aug 8 | 52 |
| Sep 10 | 49 |
| Nov 19 | 46 |
| Oct 27 | 38 |
What Changed in December
The Dec 22, 2025 batch hit inflammatory and autoimmune drugs:
- Enbrel, Simponi, Xeljanz (TNF/JAK inhibitors)
- Cosentyx, Sotyktu (IL-17/TYK2)
- Entyvio (integrin inhibitor)
- Long-acting opioids
If you manage specialty pharmacy intake or market access for immunology, that’s your workflow changing right before the holidays.
Weight Loss: The Non-Formulary Signal
Wegovy and Zepbound both carry explicit Non-Formulary designations. That’s not just restrictive—that’s a coverage posture statement. Different from plans that have complex criteria, but keep them on formulary.
Atopic Dermatitis Coverage
UHC maintains 12 policies across AD drugs:
- Dupixent (334 KB—that’s complexity)
- Rinvoq / Rinvoq LQ
- Adbry, Cibinqo, Opzelura, Ebglyss
The Dupixent medical necessity policy was last updated Oct 27. If you haven’t checked it since then, you’re working from old criteria.
Why This Matters
UHC covers more lives commercially than any other payer. Their policy decisions ripple across specialty pharmacy operations, hub workflows, and market access strategy.
I’m building infrastructure to track this:
- Automated crawling with cryptographic version tracking
- Structured extraction of approval criteria, step therapy, and denial logic
- Delta alerts when policies shift
This is what coverage governance looks like when you can prove what changed and when.
What’s Next
I’m expanding to a market sample basket across Medica, Cigna, BCBS Illinois, and Highmark (already live). Focusing first on therapeutic areas where drift hurts most: atopic dermatitis, chronic migraine, rare disease, and shifting to others thereafter.
If you’re a benefits consultant, specialty pharmacy, small plan director or market access team—this intelligence changes how you operate.
Want early access? DM me or comment below.
