Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1063 issues

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

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

How to Get Tegsedi (inotersen) Covered by UnitedHealthcare in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tegsedi (inotersen) Approved by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Tegsedi (inotersen) with strict criteria: confirmed hATTR polyneuropathy (ICD-10 E85.1), pathogenic TTR mutation, neurologist involvement, and REMS enrollment. No step therapy required, but baseline labs and monitoring plan are mandatory. First step: Gather genetic

How to Get Stelara (Ustekinumab) Covered by UnitedHealthcare in Florida: Complete Guide to Prior Authorization, Appeals, and Specialty Pharmacy Requirements

Answer Box: Getting Stelara Covered by UnitedHealthcare in Florida UnitedHealthcare now requires biosimilar ustekinumab (Steqeyma or Yesintek) instead of brand Stelara for most commercial plans as of September 2024. To get coverage: 1) Have your doctor submit prior authorization through the UHC Provider Portal documenting moderate-to-severe disease and failure of

How Long Does It Take to Get Helixate (Antihemophilic Factor, rFVIII) Approved by UnitedHealthcare in Michigan? Complete Timeline & Approval Guide

Answer Box: Getting Helixate Approved by UnitedHealthcare in Michigan Important Note: Helixate FS and Kogenate FS were discontinued in 2022-2023. Current patients need alternative factor VIII products like Kovaltry or Jivi, which follow similar approval timelines. Fastest Path: Standard prior authorization takes 15 days, expedited review 72 hours for urgent

How to Get Bylvay (odevixibat) Covered by UnitedHealthcare in New York: Prior Authorization, Appeals, and Alternative Paths

Answer Box: Getting Bylvay Covered by UnitedHealthcare in New York Bylvay (odevixibat) requires prior authorization from UnitedHealthcare in New York. Most plans use either a Notification policy (lighter requirements) or Medical Necessity policy (requires failure of 2+ conventional cholestatic treatments first). If denied, New York offers strong external appeal protections

How to Get Tysabri (Natalizumab) Covered by UnitedHealthcare in Virginia: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Tysabri Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Tysabri (natalizumab) through OptumRx, with mandatory TOUCH program enrollment and documentation of failed prior therapies. In Virginia, after internal appeals, you can request external review through the State Corporation Commission Bureau of Insurance within 120 days.

Lowering Out-of-Pocket for Imbruvica (ibrutinib) with UnitedHealthcare in Georgia: Copay Cards, Tier Exceptions & Appeals

Quick Answer: Getting Imbruvica (ibrutinib) Covered and Affordable in Georgia UnitedHealthcare requires prior authorization for Imbruvica and typically places it on a high specialty tier (Tier 4-5). For commercially insured patients, enroll in the IMBRUVICA By Your Side copay card to pay as little as $0 per prescription. If costs

How to Get Blenrep (Belantamab Mafodotin) Approved by UnitedHealthcare in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Blenrep Covered by UnitedHealthcare in Georgia Important: Blenrep (belantamab mafodotin) was withdrawn from the US market in November 2022 and remains unavailable for commercial coverage. Access is limited to clinical trials or GSK's expanded access program. UnitedHealthcare will deny coverage requests outside these pathways. If

Work With Your Doctor to Get Myalept (metreleptin) Approved by UnitedHealthcare in Texas: Complete PA Forms & Appeal Guide

Answer Box: Your Path to Myalept Approval in Texas To get Myalept (metreleptin) covered by UnitedHealthcare in Texas, you'll need confirmed generalized lipodystrophy diagnosis, documented leptin deficiency, and failed standard treatments (optimized insulin or dual lipid therapy). Your endocrinologist must be REMS-certified and submit UnitedHealthcare's specific