Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 621 issues

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
5 min read

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,
5 min read

Denied for Rebif (Interferon Beta-1a) by UnitedHealthcare in New Jersey? How to Appeal (Templates & Timelines)

Answer Box: Getting Rebif Covered by UnitedHealthcare in New Jersey Fastest path to approval: Submit prior authorization through OptumRx with complete clinical documentation including MS diagnosis (ICD-10 G35), MRI results, prior DMT failures, and neurologist prescription. If denied, schedule a peer-to-peer review within 24 hours, then file internal appeal within
7 min read

How to Get Uplizna (inebilizumab) Covered by UnitedHealthcare in Florida: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Getting Uplizna Coverage in Florida Uplizna (inebilizumab) requires prior authorization from UnitedHealthcare in Florida. To get approved: (1) Your doctor submits a PA request through the UnitedHealthcare Provider Portal with diagnosis confirmation (AQP4-positive NMOSD or IgG4-RD), specialist involvement, and HBV screening results, (2) if denied, file an internal
6 min read

Coding That Helps Get Rystiggo (Rozanolixizumab-noli) Approved by UnitedHealthcare in North Carolina: ICD-10, J-Code, and Prior Authorization Guide

Answer Box: Fast Track to Rystiggo Coverage Getting Rystiggo (rozanolixizumab-noli) covered by UnitedHealthcare in North Carolina requires proper coding and prior authorization. Use ICD-10 codes G70.00 (no exacerbation) or G70.01 (with exacerbation), bill with J-code J9333, and document AChR or MuSK antibody positivity. UnitedHealthcare requires prior authorization through
5 min read

Lowering Out-of-Pocket for Ferriprox (deferiprone) with UnitedHealthcare in Illinois: Copay, Tiering & Assistance Programs

Answer Box: Quick Cost Reduction Strategy Ferriprox (deferiprone) costs with UnitedHealthcare in Illinois can be significantly reduced through manufacturer copay assistance (eligible commercial patients pay as little as $0), tier exception requests for high specialty copays, and Illinois' robust external review process with a 52% overturn rate. Start by
5 min read

How to Get Raxone (idebenone) Covered by UnitedHealthcare in Florida: Prior Authorization, Appeals, and Cost-Saving Strategies

Quick Answer: Getting Raxone Covered by UnitedHealthcare in Florida Raxone (idebenone) requires prior authorization from UnitedHealthcare's OptumRx specialty pharmacy network, with coverage limited to exceptional circumstances since it's not FDA-approved in the US. Your fastest path: 1) Have your doctor submit a comprehensive prior authorization with
6 min read

Myths vs. Facts: Getting Rapivab (peramivir) Covered by UnitedHealthcare in Pennsylvania

Answer Box: Getting Rapivab Covered by UnitedHealthcare in Pennsylvania Rapivab (peramivir) requires prior authorization through UnitedHealthcare's OptumRx and is typically non-formulary, but approval is possible with proper documentation. Key requirements: symptoms within 48 hours, positive flu test, and documented failure/contraindication of oral antivirals. If denied, Pennsylvania'
6 min read

Work With Your Doctor to Get Juxtapid (lomitapide) Approved by UnitedHealthcare in Florida: Provider Collaboration Guide

Quick Answer: Getting Juxtapid Approved Through UnitedHealthcare in Florida Juxtapid (lomitapide) requires strict prior authorization from UnitedHealthcare, including documented failure of Repatha and Evkeeza, REMS program compliance, and specialist prescribing. Your doctor must submit genetic confirmation of homozygous familial hypercholesterolemia (HoFH), baseline liver function tests, and proof of low-fat diet
7 min read