Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 128 issues

Coding That Helps Get Elaprase (Idursulfase) Approved in Virginia with UnitedHealthcare: ICD-10, HCPCS/J-Code, and NDC Guide

Answer Box: Getting Elaprase Covered by UnitedHealthcare in Virginia Fast track to approval: Use ICD-10 code E76.1 (Hunter syndrome), HCPCS J1743 for billing, and NDC 54092-0700-01. Submit prior authorization through UnitedHealthcare Provider Portal with enzymatic/genetic test results confirming Hunter syndrome diagnosis. If denied, file Virginia external review using
6 min read

How to Get Kineret (anakinra) Covered by UnitedHealthcare in Washington: PA Requirements, Appeals, and Success Strategies

Answer Box: Getting Kineret Covered by UnitedHealthcare in Washington UnitedHealthcare covers Kineret (anakinra) in Washington with prior authorization after documented failure of at least one DMARD for rheumatoid arthritis, or with confirmed DIRA diagnosis. The fastest path: have your rheumatologist submit clinical documentation of prior DMARD trials through UnitedHealthcare'
5 min read

How to Get Xembify Approved by UnitedHealthcare in Illinois: Timeline, Requirements & Appeal Process

Answer Box: Getting Xembify Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Xembify with strict medical necessity criteria including documented primary immunodeficiency, infection history, and lab evidence. The fastest path: gather complete clinical documentation (diagnosis, ICD-10 codes, prior therapies, lab results), submit via the UHC Provider Portal, and
6 min read

How to Get Epidiolex (Cannabidiol) Covered by UnitedHealthcare in North Carolina: Appeals, Alternatives & Exception Paths

Answer Box: Getting Epidiolex Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Epidiolex (cannabidiol) with different criteria based on your seizure disorder. For Dravet syndrome or tuberous sclerosis complex, approval may be granted based on diagnosis alone. For Lennox-Gastaut syndrome, you must document failed trials of two
6 min read

Myths vs. Facts: Getting Mepsevii (Vestronidase Alfa) Covered by UnitedHealthcare in Washington

Answer Box: Getting Mepsevii Covered by UnitedHealthcare in Washington Quick Facts: UnitedHealthcare requires prior authorization for Mepsevii (vestronidase alfa-vjbk) in Washington. Success depends on confirmed MPS VII diagnosis through enzyme testing or genetic analysis, specialist prescriber, and proper documentation—not common myths about automatic coverage or step therapy requirements. Fastest
7 min read

If Zanzalintinib (XL092) Isn't Approved by UnitedHealthcare in California: Formulary Alternatives & Exception Paths

Answer Box: Getting Zanzalintinib (XL092) Covered by UnitedHealthcare in California Zanzalintinib (XL092) is investigational and typically not covered by UnitedHealthcare outside clinical trials. Your fastest paths: 1) Request compassionate use through Exelixis (drug provided free), 2) Try covered multi-target TKI alternatives like cabozantinib or lenvatinib with prior authorization, or 3)
5 min read

The Requirements Checklist to Get Poteligeo (mogamulizumab-kpkc) Covered by UnitedHealthcare in Florida: Forms, Appeals, and Documentation Guide

Quick Answer: Getting Poteligeo Covered by UnitedHealthcare in Florida Poteligeo (mogamulizumab-kpkc) requires prior authorization through OptumRx for UnitedHealthcare members in Florida. Your fastest path to approval: (1) Confirm you have relapsed/refractory mycosis fungoides or Sézary syndrome after ≥1 prior systemic therapy, (2) Submit complete clinical documentation via the UnitedHealthcare
5 min read

How to Get Trikafta (Elexacaftor/Tezacaftor/Ivacaftor) Covered by UnitedHealthcare in Florida: Complete Guide to Prior Authorization, Appeals, and State Protections

Quick Answer: Getting Trikafta Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Trikafta (elexacaftor/tezacaftor/ivacaftor) with specific criteria: patient must be 2+ years old with cystic fibrosis and have at least one F508del mutation or FDA-responsive CFTR mutation confirmed by lab testing. Submit PA through OptumRx with
6 min read

How to Get Pomalyst (Pomalidomide) Covered by UnitedHealthcare in Pennsylvania: Complete PA Guide and Appeals Process

Answer Box: Getting Pomalyst Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Pomalyst (pomalidomide) with strict step therapy requirements. To get approved, you need documented failure of at least one immunomodulatory agent (like lenalidomide), proteasome inhibitor, or anti-CD38 therapy, plus complete REMS program enrollment. First step today: Have
6 min read