By Counterforce Health Team in Vitrakvi (larotrectinib) —

How to Get Vitrakvi (Larotrectinib) Covered by UnitedHealthcare in Texas: Complete Forms, Appeals & Contact Guide

Answer Box: Getting Vitrakvi Covered in Texas

UnitedHealthcare requires prior authorization for Vitrakvi (larotrectinib) in Texas. For patients under 19, approval requires only age verification. Adults need documented NTRK gene fusion, metastatic/unresectable tumor, and no satisfactory alternatives. Submit the UnitedHealthcare PA form with molecular testing results through the provider portal. If denied, file internal appeals within 180 days, then request Texas Independent Review Organization (IRO) review. Contact TRAK Assist at 1-844-634-8725 for enrollment support.

Table of Contents

  1. Start Here: Verify Your Plan & Find Forms
  2. Prior Authorization Forms & Requirements
  3. Submission Portals & Upload Process
  4. Fax Numbers & Mailing Addresses
  5. Specialty Pharmacy Enrollment
  6. Support Lines & Who to Call
  7. Texas Appeals Process & IRO
  8. Common Denial Reasons & Solutions
  9. Cost Assistance Programs
  10. FAQ

Start Here: Verify Your Plan & Find Forms

Before starting the Vitrakvi approval process, confirm your UnitedHealthcare plan details and locate the current forms.

Step 1: Check Your Coverage Type

  • Commercial/Employer Plans: Use standard UnitedHealthcare PA process
  • Medicare Advantage: Follow Medicare-specific timelines
  • Medicaid: Different appeal rights apply
  • ERISA Self-Funded Plans: Federal appeals process only
Note: Texas Independent Review Organization (IRO) rights apply only to state-regulated plans, not ERISA, Medicare, or Medicaid plans.

Step 2: Locate Current Forms The most current Vitrakvi prior authorization form is effective April 1, 2025. Access it through the UnitedHealthcare Provider Portal under Pharmacy → Prior Authorization Forms → Vitrakvi.

Prior Authorization Forms & Requirements

Coverage Criteria for Vitrakvi

Patient Age Requirements Authorization Period
Under 19 years Age verification only 12 months
19+ years All criteria below must be met 12 months

Adult Coverage Requirements:

  1. Solid tumor diagnosis (any histology)
  2. NTRK gene fusion positive with molecular testing documentation
  3. No known resistance mutations (TRKA G595R, G623R, G696A, F617L)
  4. Metastatic or unresectable disease
  5. No satisfactory alternatives or disease progression after prior therapy

Required Documentation

Essential Documents to Include:

  • Completed UnitedHealthcare Vitrakvi PA form
  • Molecular pathology report showing NTRK gene fusion
  • Oncologist notes confirming unresectability/metastasis
  • Prior therapy documentation (treatments tried and outcomes)
  • Patient insurance cards (front and back copies)

Clinician Corner: Medical Necessity Letter Checklist

When preparing supporting documentation, ensure your medical necessity letter includes:

✓ Diagnosis: Specific tumor type with ICD-10 code
✓ Molecular testing: NTRK fusion type and testing method
✓ Disease status: Metastatic/unresectable with staging
✓ Prior treatments: Specific therapies tried, duration, and reason for discontinuation
✓ Clinical rationale: Why Vitrakvi is appropriate now
✓ Guideline support: Reference to NCCN or FDA labeling
✓ Monitoring plan: How you'll assess treatment response

Submission Portals & Upload Process

UnitedHealthcare Provider Portal

Access: UHCprovider.com

  • Requires One Healthcare ID registration
  • Use Prior Authorization and Notification tool
  • Upload lab documentation directly
  • Track submission status in real-time

Upload Requirements:

  • All documents must be legible and current
  • Lab reports showing NTRK fusion testing results
  • Clinical notes supporting medical necessity
  • Complete PA form with all required signatures

Alternative Submission Methods

If portal access isn't available:

  • Fax: Use number provided on PA form or member's denial letter
  • Mail: Include all documentation with cover sheet
Tip: Portal submission provides fastest processing and automatic confirmation receipts.

Fax Numbers & Mailing Addresses

UnitedHealthcare Appeals Contacts

Type Method Contact Timeline
Standard Appeal Mail P.O. Box 30555, Salt Lake City, UT 84130-0555 15-30 days
Expedited Appeal Fax 1-888-571-3515 72 hours
Vitrakvi Enrollment Fax 1-888-506-8725 N/A

Cover Sheet Tips:

  • Mark urgent appeals as "EXPEDITED"
  • Include member ID and date of service
  • List all attached documents
  • Retain fax confirmation for records

Specialty Pharmacy Enrollment

TRAK Assist Program

Contact: 1-844-634-8725
Fax: 1-888-506-8725

Services Provided:

  • Prior authorization support
  • Insurance verification
  • Patient education and adherence support
  • $0 copay program for eligible commercial patients
  • Bridge supply during approval process

Network Specialty Pharmacies

Pharmacy Phone Fax
Accredo 1-855-540-1797 1-877-327-7120
CVS Specialty 1-800-790-1698 1-855-296-0210
US Bioservices 1-833-230-1407 1-833-878-5917

Enrollment Process:

  1. Complete Vitrakvi prescription and enrollment form
  2. Attach insurance card copies (front and back)
  3. Fax completed forms to 1-888-506-8725
  4. Follow up with TRAK Assist for status updates

Support Lines & Who to Call

Key Contact Numbers

For Patients:

  • TRAK Assist: 1-844-634-8725 (enrollment and support)
  • UnitedHealthcare Member Services: Number on your insurance card
  • Texas Department of Insurance: 1-800-252-3439 (consumer help)

For Providers:

  • UnitedHealthcare Provider Services: 1-888-842-3211
  • Prior Authorization Status: Through provider portal
  • Peer-to-Peer Review: Request through provider portal

What to Ask When Calling:

  • Current PA status and any missing documentation
  • Specific denial reasons and required evidence
  • Timeline for decision and next steps
  • Expedited review eligibility for urgent cases

Texas Appeals Process & IRO

Internal Appeals Timeline

Standard Process:

  1. File within 180 days of denial notice
  2. Pre-service appeals: 15 calendar days for decision
  3. Post-service appeals: 30 calendar days for decision
  4. Expedited appeals: 72 hours for urgent cases

Texas Independent Review Organization (IRO)

After exhausting internal appeals, Texas residents can request external review for medical necessity denials.

IRO Contact: 1-866-554-4926 (TDI Quality Assurance Office)

IRO Process:

  • Available for medical necessity, experimental/investigational denials
  • UnitedHealthcare pays for the review
  • Timeline: 5 days for emergencies, 20 days for standard cases
  • Decision is binding on UnitedHealthcare
  • Must request within 4 months of final internal denial
Important: IRO review only applies to state-regulated plans. ERISA, Medicare, and Medicaid plans follow different appeal processes.

Common Denial Reasons & Solutions

Denial Reason Solution Required Documentation
Missing NTRK fusion test Submit molecular pathology report Lab report with fusion type and testing method
Tumor is resectable Provide surgical consultation Oncologist note explaining unresectability
Prior therapy not documented Submit treatment history Records of previous therapies and outcomes
Non-specialist prescriber Transfer to oncologist Prescription from board-certified oncologist
Step therapy not met Request medical exception Documentation of contraindications or failures

Script for Peer-to-Peer Review Request

"I'm requesting a peer-to-peer review for [patient name], member ID [number], for Vitrakvi coverage. The patient has NTRK fusion-positive [tumor type] that is metastatic and has progressed on [prior therapies]. The molecular testing confirms [fusion type] and the patient meets all coverage criteria per your policy. When can we schedule the clinical review?"

Cost Assistance Programs

Manufacturer Support

TRAK Assist Program Benefits:

  • $0 copay for eligible commercial patients
  • Bridge therapy during PA process
  • Prior authorization assistance
  • Patient education and adherence support

Eligibility: Commercial insurance patients meeting income requirements

Additional Resources

  • Patient Access Network Foundation: Grants for cancer medications
  • CancerCare: Financial assistance and copay support
  • State pharmaceutical assistance programs: Contact Texas Health and Human Services

FAQ

How long does UnitedHealthcare PA take in Texas? Standard PA decisions are typically issued within 15 days for pre-service requests. Expedited reviews for urgent cases must be completed within 72 hours.

What if Vitrakvi is non-formulary on my plan? Non-formulary medications can still be covered through medical exception requests. Submit the PA form with strong clinical justification and documentation that formulary alternatives are inappropriate.

Can I request an expedited appeal? Yes, if a delay would seriously jeopardize your health. Include a physician statement explaining the urgency and use the expedited fax number: 1-888-571-3515.

Does step therapy apply if I've failed treatments outside Texas? Treatment history from any location counts toward step therapy requirements. Provide documentation of all prior therapies, regardless of where they were received.

What happens if my internal appeal is denied? Texas residents with state-regulated plans can request Independent Review Organization (IRO) review. Contact TDI at 1-866-554-4926 within 4 months of the denial.

How do I know if my plan is eligible for Texas IRO? State-regulated commercial plans qualify for IRO. ERISA self-funded employer plans, Medicare, and Medicaid follow different appeal processes and are not eligible for Texas IRO review.

About Counterforce Health: Counterforce Health helps patients, clinicians, and specialty pharmacies turn insurance denials into targeted, evidence-backed appeals. Our platform analyzes denial letters and plan policies to draft point-by-point rebuttals with the right clinical evidence and procedural requirements, reducing back-and-forth and improving approval rates.

When navigating complex prior authorization requirements like those for Vitrakvi, having expert support can make the difference between approval and denial. Counterforce Health's systematic approach ensures that appeals meet payer-specific requirements while incorporating the clinical evidence that matters most to coverage decisions.

Sources & Further Reading

Disclaimer: This information is for educational purposes only and does not constitute medical or legal advice. Coverage decisions depend on individual plan terms and medical circumstances. Always consult with your healthcare provider and insurance plan for specific guidance. For assistance with Texas insurance issues, contact the Texas Department of Insurance at 1-800-252-3439.

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