Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1061 issues

Renewing Pemazyre (Pemigatinib) Approval with UnitedHealthcare in Ohio: Complete 2025 Renewal Guide

Answer Box: Renewing Pemazyre with UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization renewal for Pemazyre (pemigatinib) every 12 months, with approval based on documented clinical response and absence of disease progression. Submit renewal requests 2-4 weeks before your current authorization expires through the UHC provider portal or by calling 866-889-8054.
6 min read

Renewing Kuvan (Sapropterin) Approval with UnitedHealthcare in Washington: 2025 Requirements & Timeline

Answer Box: Kuvan Renewal Requirements UnitedHealthcare requires annual prior authorization renewal for Kuvan (sapropterin) with specific documentation: active phenylalanine-restricted diet, sustained blood Phe reduction from baseline (typically ≥20-30%), and confirmation you're not using concurrent Palynziq therapy. Start renewal 60-90 days before expiration. Submit through the UnitedHealthcare Provider Portal
5 min read

How Long Does It Take to Get Arikayce Approved by UnitedHealthcare in Pennsylvania? Complete Timeline Guide

Answer Box: Getting Arikayce Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Arikayce (amikacin liposome inhalation) with a standard review timeline of 7-14 days from complete submission. To qualify, you must have refractory MAC lung disease with positive cultures after ≥6 months of failed combination therapy (macrolide + ethambutol
6 min read

How to Get Waylivra (Volanesorsen) Covered by UnitedHealthcare in Washington: Appeals, Forms & State Protections

Answer Box: Getting Waylivra Covered by UnitedHealthcare in Washington Waylivra (volanesorsen) is typically non-formulary on UnitedHealthcare plans, requiring an individualized coverage exception. In Washington, you have strong appeal rights including independent external review after internal denials. Fastest path: Submit a detailed prior authorization request with genetic FCS confirmation, documented treatment
7 min read

Renewing Isturisa (Osilodrostat) Approval with UnitedHealthcare in Pennsylvania: What to Prepare & When

Answer Box: Renewing Isturisa Coverage with UnitedHealthcare in Pennsylvania UnitedHealthcare typically requires annual prior authorization renewal for Isturisa (osilodrostat), with submission needed 30-60 days before expiration. Key requirements include recent 24-hour urine free cortisol (UFC) levels showing response, endocrinologist notes confirming ongoing need, and safety monitoring documentation. If renewal is
6 min read

How to Get Kuvan (Sapropterin) Covered by UnitedHealthcare in Pennsylvania: Complete Forms, Appeals & Timeline Guide

Answer Box: Getting Kuvan Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Kuvan (sapropterin) in Pennsylvania through OptumRx. You'll need PKU diagnosis documentation, phenylalanine levels, and proof of dietary management. Submit via the UnitedHealthcare Provider Portal with complete clinical records. If denied, Pennsylvania's new
6 min read

How to Get Gamifant (Emapalumab-lzsg) Covered by UnitedHealthcare in Illinois: Prior Authorization Guide 2025

Answer Box: Getting Gamifant Approved by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Gamifant (emapalumab-lzsg) as a medical-benefit specialty drug for primary HLH. Key requirements: confirmed HLH-2004 diagnostic criteria (≥5 of 8 criteria or genetic confirmation), documented failure of conventional therapy (dexamethasone + etoposide), and FDA-label dosing plan. Submit via
5 min read

How to Get Cabometyx (cabozantinib) Covered by UnitedHealthcare in Pennsylvania: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Getting Cabometyx Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Cabometyx (cabozantinib) in Pennsylvania, placing it on specialty tier 4-5 with indication-specific criteria. Your fastest path: Have your oncologist submit PA via the UHC Provider Portal with diagnosis confirmation, staging, prior therapy history, and NCCN guideline
7 min read

The Requirements Checklist to Get Idelvion (Albutrepenonacog Alfa) Covered by UnitedHealthcare in North Carolina: Prior Authorization, Appeals, and Coding Guide

Answer Box: Getting Idelvion Covered by UnitedHealthcare in North Carolina Idelvion (albutrepenonacog alfa) requires prior authorization under UnitedHealthcare through OptumRx in North Carolina. Your fastest path to approval: (1) Confirm your hemophilia B diagnosis with recent factor IX activity levels and inhibitor testing, (2) Have your hematologist submit a complete
6 min read