Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1051 issues

Lowering Out-of-Pocket for Signifor / Signifor LAR (pasireotide) with UnitedHealthcare in New Jersey: Copay, Tiering & Assistance

Quick Answer: Reducing Your Signifor LAR Costs with UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Signifor LAR (pasireotide) with potential high specialty tier costs. Key cost-reduction strategies include the manufacturer's $20 copay program for commercial insurance, foundation grants up to $13,600/year, and formulary tier
6 min read

Coding That Helps Get Elelyso (Taliglucerase Alfa) Approved in Washington with UnitedHealthcare: ICD-10, HCPCS J-Code, and Billing Guide

Answer Box: Fast Track to Elelyso Coverage Getting Elelyso (taliglucerase alfa) covered by UnitedHealthcare in Washington requires precise coding and documentation. Use ICD-10 code E75.22 for Gaucher disease, HCPCS J-code J3060 for billing (10 units per code), and calculate total dose ÷ 10 for billable units. Submit prior authorization through
6 min read

How to Get Alprolix Covered by UnitedHealthcare in New Jersey: PA Forms, Appeals, and State Resources

Answer Box: Getting Alprolix Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization (PA) for Alprolix through OptumRx, with coverage contingent on confirmed hemophilia B diagnosis, hematologist prescription, and documented failure of standard half-life factor IX therapy (≥50 exposure days). Submit PA via the UnitedHealthcare Provider Portal with medical
6 min read

Renewing Galafold (Migalastat) Coverage with UnitedHealthcare in Illinois: Timeline, Documentation, and Appeal Options

Answer Box: Renewing Galafold Coverage with UnitedHealthcare in Illinois UnitedHealthcare requires annual reauthorization for Galafold (migalastat) with documentation of positive clinical response. Submit renewal requests 30-60 days before expiration through OptumRx with specialist notes showing treatment response (reduced GL-3 levels, stable kidney function). If denied, you have 180 days for
6 min read

How to Get Hetlioz (Tasimelteon) Covered by UnitedHealthcare in Illinois: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Hetlioz Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Hetlioz (tasimelteon) with mandatory step therapy requiring a 30-day melatonin trial failure. You'll need diagnosis documentation (Non-24 sleep disorder ICD-10 G47.24 or Smith-Magenis syndrome), specialist consultation, and submission via OptumRx specialty pharmacy. First
6 min read

How to Get Tepezza (Teprotumumab) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Tepezza Coverage with UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Tepezza (teprotumumab) in New Jersey for moderate-to-severe thyroid eye disease. Your ophthalmologist or endocrinologist must submit documentation showing Clinical Activity Score ≥3, euthyroid status, and failed corticosteroid treatment via the UHC Provider Portal. If denied, New
6 min read

How to Get Photrexa (Riboflavin Ophthalmic Solution) Covered by UnitedHealthcare in Michigan: Prior Authorization Timeline & Appeals Guide

Answer Box: Getting Photrexa Covered in Michigan Photrexa (riboflavin ophthalmic solution) requires prior authorization from UnitedHealthcare for corneal cross-linking in progressive keratoconus. The fastest path to approval: (1) Submit PA through the UHC Provider Portal with serial topography showing ≥1 diopter Kmax progression over 12 months, (2) Include pachymetry confirming
5 min read

Work With Your Doctor to Get Onivyde (Irinotecan Liposome) Approved by UnitedHealthcare in Texas: PA Requirements and Appeal Scripts

Quick Answer: Getting Onivyde Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization through OptumRx for Onivyde (irinotecan liposome) in metastatic pancreatic cancer, with ECOG 0-1 status and adequate organ function documented. Your oncologist must submit clinical notes showing either first-line NALIRIFOX eligibility or gemcitabine failure, with decisions typically within
6 min read

How to Get Arcalyst (Rilonacept) Covered by UnitedHealthcare in Florida: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Arcalyst Approved by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Arcalyst (rilonacept) with 12-month approvals based on FDA indications: CAPS, DIRA, or recurrent pericarditis. Submit PA forms via the provider portal with specialist notes, diagnosis confirmation (ICD-10 codes), and clinical documentation. If denied, you have 180
5 min read