Topic

North Carolina

A collection of 449 issues

If Uptravi (Selexipag) Isn't Approved by UnitedHealthcare in North Carolina: Formulary Alternatives & Exception Paths

Answer Box: When UnitedHealthcare Denies Uptravi (Selexipag) in North Carolina UnitedHealthcare requires step therapy before approving Uptravi (selexipag) for pulmonary arterial hypertension. You'll need to try formulary alternatives first—typically PDE5 inhibitors (sildenafil, tadalafil) or endothelin receptor antagonists (ambrisentan, bosentan)—unless you qualify for an exception. If denied
6 min read

How to Get Strensiq (Asfotase Alfa) Covered by UnitedHealthcare in North Carolina: Complete Guide to Prior Authorization, Appeals, and State Protections

Answer Box: Getting Strensiq Covered by UnitedHealthcare in North Carolina Eligibility: UnitedHealthcare covers Strensiq (asfotase alfa) for pediatric-onset hypophosphatasia with prior authorization. Requirements: ALPL gene mutation documentation, low alkaline phosphatase levels, and specialist prescription (endocrinologist/geneticist). First step: Submit PA through OptumRx with complete genetic testing results and clinical documentation.
7 min read

The Requirements Checklist to Get Elfabrio (Pegunigalsidase Alfa-iwxj) Covered by UnitedHealthcare in North Carolina

Answer Box: Getting Elfabrio Covered by UnitedHealthcare in North Carolina Elfabrio (pegunigalsidase alfa-iwxj) requires prior authorization from UnitedHealthcare and is often excluded from standard formularies. The fastest path to approval: (1) Submit complete diagnostic documentation proving confirmed Fabry disease through enzyme deficiency or GLA gene testing, (2) Document step therapy
6 min read

How to Get Aldurazyme (laronidase) Covered by Humana in North Carolina: Prior Authorization, Appeals, and Documentation Guide

Answer Box: Getting Aldurazyme (laronidase) Covered by Humana in North Carolina Eligibility: Humana Medicare Advantage and dual-eligible plans require prior authorization for Aldurazyme (laronidase) using J-code J1931. Fastest path: Work with your MPS I specialist to submit a comprehensive prior authorization request including genetic/enzymatic confirmation, baseline severity assessments, and
5 min read

Work With Your Doctor to Get Onivyde (Irinotecan Liposome) Approved by UnitedHealthcare in North Carolina: PA Requirements, Appeals, and Provider Scripts

Quick Answer: Getting Onivyde Approved in North Carolina UnitedHealthcare requires prior authorization for Onivyde (irinotecan liposome) with step therapy requirements. The fastest path: work with your oncologist to submit comprehensive PA documentation showing ECOG 0-1 status, adequate organ function, and either first-line NALIRIFOX eligibility or progression after gemcitabine-based therapy. If
6 min read

Getting Symdeko/Symkevi Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Symdeko/Symkevi Covered by UnitedHealthcare in North Carolina Symdeko (tezacaftor/ivacaftor) requires prior authorization from UnitedHealthcare in North Carolina. Your CF specialist must submit documentation including genetic testing results confirming eligible CFTR mutations (like F508del), diagnosis codes, and clinical notes. Initial approval lasts 6 months with reauthorization
6 min read

How Long Does It Take to Get Humate-P Approved by UnitedHealthcare in North Carolina? Complete Timeline & Approval Guide

Quick Answer: UnitedHealthcare typically processes Humate-P prior authorization requests within 7 calendar days in North Carolina, with expedited reviews in 2 business days for urgent cases. Success requires complete VWD subtype testing, documented desmopressin failure (when applicable), and proper clinical justification. Start by gathering lab results and having your provider
5 min read