Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1144 issues

How to Get Tysabri (Natalizumab) Covered by UnitedHealthcare in Michigan: Appeals, Copay Programs & Prior Authorization

Quick Answer: Getting Tysabri Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Tysabri (natalizumab) through their Provider Portal or by calling 888-397-8129. If denied, you have internal appeal rights followed by Michigan DIFS external review within 127 days. First step today: Have your doctor submit a prior authorization
6 min read

Xospata (Gilteritinib) Approval with UnitedHealthcare in Virginia: Answers to the Most Common Questions

Answer Box: Getting Xospata Covered by UnitedHealthcare in Virginia Xospata (gilteritinib) requires prior authorization from UnitedHealthcare for relapsed/refractory AML with confirmed FLT3 mutations. Fastest approval path: Submit PA with FDA-approved FLT3 test results, prior therapy documentation, and oncologist's medical necessity letter. First step today: Have your hematologist/
5 min read

Complete Guide: Getting Imbruvica (ibrutinib) Covered by UnitedHealthcare in Pennsylvania - Prior Authorization, Appeals, and Success Strategies

Answer Box: Your Path to Imbruvica Coverage in Pennsylvania Getting Imbruvica (ibrutinib) covered by UnitedHealthcare in Pennsylvania requires prior authorization, proper diagnosis documentation, and often step therapy compliance. Most approvals take 5-15 business days with complete submissions. If denied, Pennsylvania's new external review program has overturned 50% of
6 min read

How to Get Prolastin-C Covered by UnitedHealthcare in Ohio: Appeals Guide with Forms and Timelines

Answer Box: Getting Prolastin-C Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Prolastin-C (alpha1-proteinase inhibitor), with approvals typically requiring severe AAT deficiency genotype (Pi*ZZ), documented emphysema, and specific lung function criteria. If denied, you have 21 calendar days to appeal through the UnitedHealthcare Provider Portal, followed by
7 min read

How to Get Eylea and Lucentis Covered by UnitedHealthcare in Texas: Prior Authorization Forms, Appeals, and Step Therapy Guide

Answer Box: Getting Started in Texas UnitedHealthcare requires prior authorization for both Eylea (aflibercept) and Lucentis (ranibizumab) in Texas, with step therapy typically requiring bevacizumab first unless contraindicated. Both drugs are placed in Tier 4 (Specialty) with higher copays or coinsurance. Fastest approval path: (1) Have your retina specialist submit
5 min read

How to Get Revlimid (Lenalidomide) Covered by UnitedHealthcare in California: A Complete Guide to Prior Authorization and Appeals

Quick Answer: Getting Revlimid Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Revlimid (lenalidomide) through OptumRx, with strict clinical criteria and REMS compliance. The fastest path to approval: (1) Ensure your oncologist submits a complete prior authorization with lab values, diagnosis codes, and treatment history through the UnitedHealthcare
5 min read

If Ultomiris (Ravulizumab) Isn't Approved by UnitedHealthcare in Michigan: Formulary Alternatives & Exception Strategies

Quick Answer: Your Options When Ultomiris Is Denied If UnitedHealthcare denies Ultomiris (ravulizumab) in Michigan, you have three main paths: try a formulary alternative like Soliris (eculizumab), request a formulary exception with medical necessity documentation, or pursue a formal appeal. Your fastest option is often requesting a peer-to-peer review where
6 min read