Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 619 issues

How to Get Galafold (migalastat) Covered by UnitedHealthcare in North Carolina: Requirements, Appeals, and Smart NC External Review

Answer Box: Getting Galafold Covered by UnitedHealthcare in North Carolina To get Galafold (migalastat) covered by UnitedHealthcare in North Carolina, you need: (1) confirmed Fabry disease diagnosis with amenable GLA variant documented by genetic testing, (2) specialist evaluation (nephrology, genetics, or metabolics), and (3) prior authorization submission through OptumRx with

The Complete Requirements Checklist to Get Besponsa (Inotuzumab Ozogamicin) Covered by UnitedHealthcare in Pennsylvania

Quick Answer: Getting Besponsa Covered by UnitedHealthcare in Pennsylvania Besponsa (inotuzumab ozogamicin) requires prior authorization from UnitedHealthcare for all plan types. Your fastest path to approval: 1) Gather documentation proving CD22-positive relapsed/refractory B-cell ALL and failed prior therapies, 2) Submit PA request through UnitedHealthcare Provider Portal with complete clinical

Renewing iLink® Corneal Cross-Linking Coverage with UnitedHealthcare in Virginia: Timeline, Documentation & Appeals Guide

Quick Answer: Renewing Your iLink® Coverage UnitedHealthcare requires annual prior authorization renewal for iLink® corneal cross-linking. Start the renewal process 4-6 weeks before your current authorization expires. You'll need updated corneal topography showing continued progression, a medical necessity letter from your ophthalmologist, and evidence of treatment response. Submit

Do You Qualify for Defitelio Coverage by UnitedHealthcare in Pennsylvania? Decision Tree & Next Steps

Answer Box: Your Path to Defitelio Coverage Getting Defitelio (defibrotide) covered by UnitedHealthcare in Pennsylvania requires prior authorization for hepatic VOD/SOS with organ dysfunction post-HSCT. You're likely eligible if you have confirmed hepatic veno-occlusive disease with renal or pulmonary dysfunction following hematopoietic stem cell transplant. Start by

Lowering Out-of-Pocket Costs for Carbaglu (Carglumic Acid) with UnitedHealthcare in Georgia: Copay Assistance, Tiering, and Appeals

Answer Box: Getting Carbaglu Covered by UnitedHealthcare in Georgia Fastest path to approval: Submit prior authorization with genetic/enzyme testing confirming NAGS deficiency, elevated ammonia levels, and metabolic specialist documentation through the UHC provider portal. Cost reduction: Apply for Recordati's $0 copay program for commercial plans, request tiering

Getting Pyrukynd (Mitapivat) Covered by UnitedHealthcare in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Your Path to Pyrukynd Coverage UnitedHealthcare requires strict prior authorization for Pyrukynd (mitapivat) in Washington. You'll need genetic confirmation of pyruvate kinase deficiency (≥2 PKLR variants, ≥1 missense), baseline hemoglobin ≤10 g/dL, limited transfusion history, and hematologist oversight. If denied, Washington's external review

How to Get Keppra (Levetiracetam) Covered by UnitedHealthcare in Washington: Complete Guide to Formulary Tiers, Prior Authorization & Appeals

Answer Box: Quick Path to Keppra Coverage Generic levetiracetam is typically covered as Tier 1 (preferred generic) without prior authorization on most UnitedHealthcare plans in Washington. Brand Keppra requires prior authorization and medical necessity documentation. If denied, you have 180 days to file internal appeals, then external review through Washington&

Do You Qualify for Tagrisso Coverage by UnitedHealthcare in Illinois? Decision Tree & Next Steps

Answer Box: Quick Path to Tagrisso Coverage in Illinois Yes, you likely qualify if you have NSCLC with EGFR mutations (exon 19 deletion, L858R, T790M, S768I, L861Q, or G719X). UnitedHealthcare requires prior authorization through OptumRx with mutation test results and treatment history. First step today: Have your oncologist submit a

How to Get Vitrakvi (Larotrectinib) Covered by UnitedHealthcare in California: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Vitrakvi Covered by UnitedHealthcare in California Vitrakvi (larotrectinib) requires prior authorization through OptumRx for UnitedHealthcare members in California. To get approved: (1) Submit NTRK fusion test results via the UHC provider portal, (2) document prior therapies or contraindications for step therapy exception, and (3) include oncologist notes

Renewing Stelara (Ustekinumab) Coverage with UnitedHealthcare in Michigan: 2025 Timeline, Forms, and Appeal Options

Quick Answer: Renewing Stelara Coverage with UnitedHealthcare in Michigan Important Update: UnitedHealthcare no longer covers brand-name Stelara as of September 2024. You must switch to preferred biosimilars (Steqeyma or Yesintek) or meet strict medical exception criteria. For renewals: submit documentation 30 days before current authorization expires, include clinical response evidence,