By Counterforce Health Team in Voxzogo (vosoritide) —

How to Get Voxzogo (vosoritide) Approved by UnitedHealthcare in Georgia: Complete Prior Authorization Guide

Answer Box: Getting Voxzogo Approved by UnitedHealthcare in Georgia

UnitedHealthcare covers Voxzogo (vosoritide) for pediatric achondroplasia patients under 18 with open epiphyses through prior authorization. The fastest path to approval requires: (1) confirmed FGFR3 genetic testing or clinical achondroplasia diagnosis, (2) bone age X-ray showing open growth plates, and (3) prescription from a pediatric endocrinologist, geneticist, or achondroplasia specialist. Start today by calling BioMarin RareConnections at 1-866-906-6100 for PA support and copay assistance, then gather genetic test results and recent bone age imaging for your UnitedHealthcare submission.

Table of Contents

  1. What This Guide Covers
  2. Before You Start: Verify Your Coverage
  3. Gather What You Need
  4. Submit the Prior Authorization Request
  5. Follow-Up and Timelines
  6. If You're Asked for More Information
  7. If Your Request is Denied
  8. Appeals Process in Georgia
  9. Renewal and Reauthorization
  10. Cost Savings and Patient Support
  11. Quick Reference Checklist

What This Guide Covers

This guide helps Georgia families and healthcare providers navigate UnitedHealthcare's prior authorization process for Voxzogo (vosoritide), the first FDA-approved treatment for achondroplasia in children. Whether you're facing an initial denial or preparing your first request, we'll walk through the specific requirements, timelines, and appeal options available in Georgia.

Voxzogo costs approximately $320,000 annually before insurance coverage, making proper authorization critical for access. With the right documentation and approach, most families can secure coverage through UnitedHealthcare's established criteria.

Before You Start: Verify Your Coverage

Check Your Plan Type

UnitedHealthcare offers different coverage pathways for Voxzogo depending on your specific plan:

  • Commercial plans: Use the Medical Necessity prior authorization process
  • Medicare Advantage: May have additional step therapy requirements
  • Medicaid managed care: Follow CareSource Georgia protocols if applicable
Tip: Log into your UnitedHealthcare member portal or call the number on your insurance card to confirm which prior authorization pathway applies to your plan.

Verify Network Status

Ensure your prescribing physician is in-network with UnitedHealthcare. Out-of-network specialists may require additional approvals or result in higher out-of-pocket costs.

Confirm Pharmacy Benefit Coverage

Voxzogo is typically covered under the medical benefit (not pharmacy benefit) since it requires specialized handling and administration training. Verify this with UnitedHealthcare customer service at the number on your card.

Gather What You Need

Required Documentation Checklist

Clinical Documentation:

  • FGFR3 genetic test results confirming achondroplasia (c.1138G>A or c.1138G>C; p.Gly380Arg mutation)
  • Recent bone age X-ray (hand/wrist or knee) showing open epiphyses (within 12 months)
  • Growth velocity records (baseline measurements over 12+ months preferred)
  • Clinical notes documenting achondroplasia features (macrocephaly, frontal bossing, midface retrusion, disproportionate short stature)

Prescriber Information:

  • Prescription from pediatric endocrinologist, clinical geneticist, or achondroplasia specialist
  • Provider NPI number and credentials
  • Treatment plan including dosing calculations (0.24 mg/kg subcutaneous daily)

Insurance Forms:

Submit the Prior Authorization Request

Step-by-Step Submission Process

1. Complete the Prior Authorization Form (Day 1)

2. Submit via UnitedHealthcare Provider Portal (Day 1-2)

  • Log into the UnitedHealthcare provider portal
  • Upload completed form with all supporting documents
  • Alternative: Call 866-889-8054 for phone submission guidance

3. Confirm Receipt (Day 3-5)

  • Document your submission confirmation number
  • Verify all attachments were received
  • Note the expected decision timeline (typically 15 business days for standard review)

Coverage at a Glance

Requirement What It Means Where to Find It
Age <18 years Patient must be pediatric with open growth plates Medical records
FGFR3 confirmation Genetic testing or clinical achondroplasia diagnosis Lab results or specialist evaluation
Open epiphyses Growth plates still active on bone age X-ray Recent imaging (within 12 months)
Specialist prescriber Pediatric endocrinologist, geneticist, or achondroplasia expert Provider credentials
No limb surgery No lengthening surgery in past 18 months or planned Medical history

Follow-Up and Timelines

Georgia-Specific Timelines

  • Standard review: 15 business days from complete submission
  • Expedited review: 72 hours for urgent medical situations
  • Appeals deadline: 180 days from denial date for internal appeals
  • External review deadline: 60 days from final internal denial in Georgia

Sample Follow-Up Script

When calling UnitedHealthcare (use number on insurance card):

"Hi, I'm calling to check the status of a prior authorization request for Voxzogo for my child [patient name], member ID [number]. The reference number is [PA number]. Can you tell me the current status and if any additional information is needed?"

Document the representative's name, date, and any reference numbers provided.

If You're Asked for More Information

Common Additional Requests

Medical Necessity Questions:

  • Provide growth velocity data showing need for intervention
  • Include photos documenting achondroplasia features (with patient consent)
  • Submit specialist letter explaining why Voxzogo is appropriate now

Alternative Treatment Documentation:

  • Note that no other FDA-approved pharmacologic treatments exist for achondroplasia
  • Document any previous supportive care measures tried
Clinician Corner: When writing medical necessity letters, emphasize that Voxzogo is the only FDA-approved treatment for achondroplasia and that early intervention during active growth periods provides optimal benefit. Include specific growth velocity measurements and reference the FDA label supporting use in patients ≥2 years with open epiphyses.

If Your Request is Denied

Common Denial Reasons & Solutions

Denial Reason How to Fix It
Missing genetic confirmation Submit FGFR3 test results or detailed clinical evaluation
Epiphyses status unclear Provide recent bone age X-ray with radiologist interpretation
Prescriber not qualified Transfer care to pediatric endocrinologist or geneticist
Insufficient growth data Compile 12+ months of height/weight measurements
Age requirements not met Verify patient is <18 years with documentation

Peer-to-Peer Review Request

If initially denied, request a peer-to-peer review where your specialist can speak directly with UnitedHealthcare's medical director. This often resolves denials based on clinical complexity.

Sample Script for Requesting P2P:

"I'd like to request a peer-to-peer review for the Voxzogo denial. Can you connect me with the medical director who made this decision? My patient has confirmed achondroplasia with open epiphyses and meets all FDA criteria."

Appeals Process in Georgia

Internal Appeals (First Step)

Timeline: File within 180 days of denial date Process:

  1. Submit appeal letter explaining why coverage should be approved
  2. Include new clinical information if available
  3. Reference specific UnitedHealthcare policy criteria met
  4. Request expedited review if medically urgent

External Review (Final Step)

If UnitedHealthcare upholds the denial, Georgia residents can request external review through the Georgia Department of Insurance.

Key Details:

  • Deadline: 60 days from final internal denial
  • Cost: Free for consumers
  • Timeline: 30 business days for standard review, 72 hours for urgent cases
  • Contact: Georgia DOI Consumer Services at 1-800-656-2298

The external review is conducted by independent physicians and is binding on UnitedHealthcare if decided in your favor.

From Our Advocates: We've seen families successfully overturn Voxzogo denials by providing comprehensive growth data and emphasizing the time-sensitive nature of treatment during active growth periods. The key is demonstrating that delaying treatment reduces the medication's effectiveness, making immediate coverage medically necessary.

Renewal and Reauthorization

Annual Reauthorization Requirements

UnitedHealthcare approves Voxzogo for 12-month periods. For renewal, you'll need:

  • Continued open epiphyses: New bone age X-ray showing active growth plates
  • Clinical response documentation: Improved growth velocity compared to baseline
  • Ongoing specialist care: Continued prescription from qualified provider
  • No planned surgeries: Confirmation that limb-lengthening surgery isn't planned

Calendar Reminders

Set reminders 60-90 days before your authorization expires to begin the renewal process. This prevents treatment interruptions.

Cost Savings and Patient Support

BioMarin RareConnections Program

Eligibility: Georgia residents with commercial insurance (not Medicare/Medicaid) Benefits: Covers copays, coinsurance, and deductibles for Voxzogo Contact: 1-866-906-6100 (Monday-Friday, 8AM-8PM ET)

The program also provides:

  • Prior authorization support and case management
  • Appeals assistance if coverage is denied
  • Coordination with specialty pharmacies for delivery

Counterforce Health specializes in turning insurance denials into successful appeals for specialty medications like Voxzogo. Our platform analyzes denial letters and creates targeted, evidence-backed appeals that address payer-specific criteria. By combining clinical expertise with payer policy knowledge, we help families navigate complex prior authorization requirements and secure coverage for life-changing treatments.

Additional Financial Resources

  • Patient Advocate Foundation: Provides case management for insurance issues
  • National Organization for Rare Disorders (NORD): Offers patient assistance programs
  • Good Days: Chronic disease financial assistance (verify Voxzogo eligibility)

Quick Reference Checklist

Before Submitting:

  • Patient <18 years old with achondroplasia diagnosis
  • FGFR3 genetic test results or clinical evaluation
  • Bone age X-ray showing open epiphyses (within 12 months)
  • Prescription from pediatric endocrinologist/geneticist
  • Growth velocity data (12+ months preferred)
  • Completed UnitedHealthcare PA form

After Submission:

  • Document confirmation number and expected timeline
  • Set calendar reminder to follow up in 10 business days
  • Prepare appeal materials if needed
  • Contact BioMarin RareConnections for copay assistance

If Denied:

  • Request peer-to-peer review within 5 business days
  • File internal appeal within 180 days
  • Consider external review through Georgia DOI if needed
  • Work with Counterforce Health for specialized appeals support

Frequently Asked Questions

How long does UnitedHealthcare prior authorization take in Georgia? Standard review takes 15 business days from complete submission. Urgent cases can be expedited to 72 hours with clinical justification.

What if Voxzogo isn't on my formulary? Voxzogo is typically covered under the medical benefit, not pharmacy formulary. Verify with UnitedHealthcare which benefit applies to your plan.

Can I request expedited review? Yes, if delaying treatment poses serious health risks. Your specialist must provide clinical justification for urgent review.

Does step therapy apply to Voxzogo? Generally no, since there are no FDA-approved alternatives for achondroplasia. However, some plans may require documentation of supportive care measures tried.

What happens if my child's growth plates close during treatment? Treatment should be discontinued when epiphyses close. This is monitored through regular bone age X-rays every 6-12 months.

Disclaimer: This guide provides general information about insurance coverage and is not medical advice. Always consult with your healthcare provider about treatment decisions and work directly with your insurance company for plan-specific requirements. For personalized assistance with insurance appeals and prior authorization, consider consulting with Counterforce Health or other patient advocacy organizations.

Sources & Further Reading

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