Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1066 issues

UnitedHealthcare's Coverage Criteria for Cabometyx (cabozantinib) in Ohio: What Counts as "Medically Necessary"?

Answer Box: Getting Cabometyx Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Cabometyx (cabozantinib) with specific medical necessity criteria by cancer type. Fastest path: Have your oncologist submit PA through the UHC Provider Portal with complete diagnosis, staging, prior therapy documentation, and imaging results. For RCC: Stage IV
5 min read

UnitedHealthcare's Coverage Criteria for Firdapse (amifampridine) in New Jersey: What Counts as "Medically Necessary"?

Answer Box: Getting Firdapse Approved by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Firdapse (amifampridine) through OptumRx with confirmed LEMS diagnosis by a neurologist, diagnostic testing (EMG and VGCC antibodies), and no seizure history. No step therapy is required. If denied, you have 60 days to appeal internally,
6 min read

How to Get Oxlumo (lumasiran) Covered by UnitedHealthcare in New York: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Oxlumo Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Oxlumo (lumasiran) with genetic confirmation of PH1, elevated urinary oxalate levels, and specialist prescriber documentation. Submit through the UHC provider portal with complete clinical records. If denied, you have 30 days for internal appeal, then
6 min read

How to Get Pomalyst (Pomalidomide) Covered by UnitedHealthcare in Florida: Coding, Appeals, and REMS Requirements

Answer Box: Getting Pomalyst Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Pomalyst (pomalidomide) with specific documentation: C90.02 (multiple myeloma in relapse) ICD-10 code, proof of prior lenalidomide and proteasome inhibitor failure, and PS-Pomalidomide REMS enrollment. Submit via the UHC Provider Portal with pathology reports, treatment history,
6 min read

How to Get Zokinvy (lonafarnib) Covered by UnitedHealthcare in Washington: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Zokinvy Coverage in Washington UnitedHealthcare requires prior authorization for Zokinvy (lonafarnib) with specific criteria: confirmed HGPS or processing-deficient progeroid laminopathy diagnosis, age ≥12 months, BSA ≥0.39 m², and genetic testing confirmation. The fastest path: submit complete documentation including genetic test results and specialist consultation through UnitedHealthcare&
6 min read

How to Get Gilenya (fingolimod) Covered by UnitedHealthcare in North Carolina: Prior Authorization Forms, Appeal Timelines, and External Review Rights

Answer Box: Getting Gilenya Covered in North Carolina UnitedHealthcare requires prior authorization for Gilenya (fingolimod) through OptumRx, typically requiring documentation of ≥2 failed MS therapies plus baseline safety tests (EKG, eye exam, labs). North Carolina provides 72-hour step therapy exception decisions and 120-day external review rights through Smart NC after
6 min read

How to Get Rezlidhia (Olutasidenib) Covered by UnitedHealthcare in Virginia: Complete PA Guide and Appeals Process

Answer Box: Getting Rezlidhia Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Rezlidhia (olutasidenib) with strict documentation of IDH1 mutation and relapsed/refractory AML status. Submit via OptumRx e-PA portal with molecular testing results, treatment history, and monitoring plan. If denied, Virginia's State Corporation Commission provides
6 min read

Get Crysvita (Burosumab) Covered by UnitedHealthcare in New Jersey: Prior Authorization, Appeals & Cost Assistance Guide

Answer Box: Fast Track to Coverage Getting Crysvita (burosumab) covered by UnitedHealthcare in New Jersey requires prior authorization with genetic testing or elevated FGF23 levels, specialist involvement, and documentation of failed conventional therapy (especially for adults). Submit through the UnitedHealthcare provider portal with complete medical records. If denied, you have
6 min read

How to Get Orkambi (lumacaftor/ivacaftor) Covered by UnitedHealthcare in Washington: Prior Authorization, Appeals, and Coding Guide

Answer Box: Getting Orkambi Covered in Washington UnitedHealthcare requires prior authorization for Orkambi (lumacaftor/ivacaftor) based on confirmed cystic fibrosis diagnosis, homozygous F508del CFTR mutation documentation, and prescription by a CF specialist. Submit through OptumRx with genetic lab results, ICD-10 E84.0-E84.9, and clinical notes. If denied, Washington residents
6 min read