Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1143 issues

How to Get Humate-P Covered by UnitedHealthcare in Illinois: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Humate-P Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Humate-P (antihemophilic factor/von Willebrand factor complex) and typically enforces step therapy requiring trial of desmopressin (DDAVP) first, unless contraindicated. If denied, you have 30 days for internal appeals and up to 4 months for Illinois
6 min read

How to Get Garadacimab (Andembry) Covered by UnitedHealthcare in Illinois: Timeline, Appeals & Documentation

Quick Answer: Getting Garadacimab Covered by UnitedHealthcare in Illinois Garadacimab (Andembry) requires prior authorization from UnitedHealthcare through OptumRx. The fastest approval path involves submitting complete clinical documentation showing confirmed HAE diagnosis, failed prior therapies, and REMS compliance within 1-5 business days. If denied, Illinois residents have strong appeal rights with
6 min read

How to Get Hetlioz (Tasimelteon) Covered by UnitedHealthcare in Washington: PA Forms, Appeals, and Cost Guide

Answer Box: Getting Hetlioz Approved by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Hetlioz (tasimelteon) with mandatory melatonin step therapy and specialty pharmacy dispensing through OptumRx. Coverage is limited to FDA-approved indications: Non-24-hour sleep-wake disorder in totally blind adults and Smith-Magenis syndrome sleep disturbances. Fastest approval path: 1) Get
5 min read

How to Get Amvuttra (Vutrisiran) Covered by UnitedHealthcare in Virginia: Complete Prior Authorization Guide

Quick Answer: Getting Amvuttra Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Amvuttra (vutrisiran) with specific criteria: confirmed hATTR amyloidosis with genetic testing, specialist prescription, and stage documentation. Submit through OptumRx with complete clinical records. If denied, Virginia offers external review through the State Corporation Commission within 120
6 min read

Getting Entresto (Sacubitril/Valsartan) Covered by UnitedHealthcare in New Jersey: Complete Guide to Prior Authorization and Appeals

Quick Answer: UnitedHealthcare requires prior authorization for Entresto in New Jersey with specific criteria: heart failure diagnosis, LVEF ≤40% or structural heart disease, NYHA Class II-IV, cardiologist prescription, and discontinuation of ACE inhibitors/ARBs. Submit through the UnitedHealthcare provider portal or fax to 1-866-434-5523. If denied, you have 180 days
5 min read

Getting Mepsevii (Vestronidase Alfa) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Approval To get Mepsevii (vestronidase alfa-vjbk) covered by UnitedHealthcare in New Jersey: Submit prior authorization through OptumRx with complete MPS VII diagnostic proof (enzyme assay, genetic testing, elevated uGAGs) from a metabolic specialist. If denied, file internal appeal within 180 days, then external review through
7 min read