Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1058 issues

Myths vs. Facts: Getting Filsuvez (birch triterpenes topical gel) Covered by UnitedHealthcare in Pennsylvania

Answer Box: Getting Filsuvez (birch triterpenes topical gel) covered by UnitedHealthcare in Pennsylvania requires prior authorization with genetic confirmation of dystrophic or junctional epidermolysis bullosa, wound documentation, and age ≥6 months. First step: enroll in Chiesi Total Care for PA support. If denied, Pennsylvania's external review program overturns
5 min read

How to Get Myozyme (Alglucosidase Alfa) Covered by UnitedHealthcare in Georgia: Complete Appeals Guide with Forms and Timelines

UnitedHealthcare requires prior authorization for Myozyme (alglucosidase alfa) in Georgia with confirmed Pompe disease diagnosis, specialist documentation, and genetic testing. Submit via the UHC Provider Portal with enzyme assay results, GAA genetic confirmation, and medical necessity letter. If denied, file internal appeals within 180 days, then Georgia external review within
5 min read

How to Get Luxturna Covered by UnitedHealthcare in Virginia: Complete Forms Guide and Appeal Process

Answer Box: Getting Luxturna Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Luxturna through OptumRx, with strict criteria including confirmed biallelic RPE65 mutations and retinal viability testing. Start today: (1) Verify your plan uses OptumRx for specialty drugs, (2) obtain CLIA-certified genetic testing showing biallelic RPE65 mutations, and
5 min read

How to Get Uptravi (Selexipag) Covered by UnitedHealthcare in California: Complete Guide with Forms, Appeals, and Timelines

Answer Box: Getting Uptravi Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Uptravi (selexipag) and typically enforces step therapy requiring prior trials of other PAH medications. To get approval: 1) Submit PA through the UnitedHealthcare Provider Portal with complete WHO Group I PAH documentation and medication history, 2)
6 min read

How to Get Jakafi (Ruxolitinib) Covered by UnitedHealthcare in Pennsylvania: Complete Appeals Guide

Quick Answer: Getting Jakafi Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Jakafi (ruxolitinib) in Pennsylvania. For myelofibrosis, you need intermediate/high-risk disease documentation. For polycythemia vera, you must document hydroxyurea failure after ≥14 days at maximum tolerated dose. Submit PA requests via the UHC Provider Portal or
6 min read

How to Get Mepsevii (Vestronidase Alfa-vjbk) Covered by UnitedHealthcare in Texas: Complete PA Guide and Appeals Process

Answer Box: Getting Mepsevii Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Mepsevii (vestronidase alfa-vjbk) in Texas, with coverage under the medical benefit using HCPCS J3397. Submit PA via OptumRx Provider Portal with confirmed MPS VII diagnosis (enzyme deficiency + GUSB genetics), specialist documentation, and baseline assessments. Standard review
6 min read

How to Get Hemlibra (emicizumab-kxwh) Covered by UnitedHealthcare in Ohio: Complete PA Guide with Forms, Appeals, and State Protections

Answer Box: Getting Hemlibra Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Hemlibra (emicizumab-kxwh) in Ohio with documented hemophilia A diagnosis, bleeding history, and weight-based dosing plan. Ohio law provides step-therapy protections and external review rights. First step: Submit PA through UnitedHealthcare provider portal with complete clinical documentation
6 min read

The Requirements Checklist to Get Naglazyme (Galsulfase) Covered by UnitedHealthcare in Florida: Forms, Appeals, and Clinical Criteria

Answer Box: Getting Naglazyme Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Naglazyme (galsulfase) through OptumRx, with no step therapy requirements identified for MPS VI. Submit via UnitedHealthcare Provider Portal with confirmed MPS VI diagnosis (enzyme assay or genetic testing), baseline functional assessments, and medical necessity letter. First
6 min read

The Requirements Checklist to Get Kalydeco (ivacaftor) Covered by UnitedHealthcare in Pennsylvania: Complete PA Guide with Forms and Appeals

Answer Box: Fast Track to Kalydeco Coverage To get Kalydeco (ivacaftor) covered by UnitedHealthcare in Pennsylvania: Submit prior authorization through OptumRx with confirmed cystic fibrosis diagnosis, FDA-cleared CFTR genetic test showing responsive mutation (like G551D or R117H), and CF specialist documentation. If denied, use Pennsylvania's Independent External Review—
5 min read