Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1097 issues

How to Get Pombiliti (Cipaglucosidase Alfa) Covered by UnitedHealthcare in Michigan: Complete Prior Authorization and Appeals Guide

Quick Answer: Pombiliti (cipaglucosidase alfa) requires prior authorization from UnitedHealthcare in Michigan. You'll need confirmed late-onset Pompe disease diagnosis, weight ≥40 kg, and documented lack of improvement on prior enzyme replacement therapy. Submit through OptumRx with GAA enzyme results, genetic testing, and ERT failure documentation. If denied, use
7 min read

Work With Your Doctor to Get Rinvoq (Upadacitinib) Approved by UnitedHealthcare in Virginia: Complete Provider Collaboration Guide

Quick Answer: Getting Rinvoq Approved in Virginia UnitedHealthcare requires prior authorization for Rinvoq (upadacitinib) with mandatory step therapy—typically requiring failure of at least one TNF inhibitor biologic first. Your fastest path: work with your rheumatologist to submit a comprehensive prior authorization through OptumRx including documented TNF failure, required lab
6 min read

Getting Qalsody (Tofersen) Approved by UnitedHealthcare in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Qalsody Coverage UnitedHealthcare covers Qalsody (tofersen) for ALS patients with confirmed SOD1 mutations, but requires prior authorization with specific documentation. First step: Have your neurologist gather your genetic test showing pathogenic SOD1 mutation, baseline ALSFRS-R score, and ALS diagnosis notes. Submit through UnitedHealthcare's
6 min read

Renewing Kineret (anakinra) Approval with UnitedHealthcare in North Carolina: 2025 Timeline, Forms, and Appeal Guide

Answer Box: Kineret Renewal with UnitedHealthcare in North Carolina UnitedHealthcare requires annual prior authorization renewal for Kineret (anakinra) managed through OptumRx. Start the renewal process 60 days before your current authorization expires by scheduling a follow-up visit with your specialist. Submit the complete renewal packet 30 days before expiration to
6 min read

How to Get Orladeyo (berotralstat) Covered by UnitedHealthcare in Washington: Complete Guide to Forms, Appeals, and Timelines

Answer Box: Getting Orladeyo Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Orladeyo (berotralstat) with documented HAE diagnosis, step therapy completion, and specialty pharmacy dispensing. Submit PA via UnitedHealthcare Provider Portal or fax to 1-844-403-1027 within 24-72 hours for electronic requests. If denied, file internal appeals within 180
5 min read

How to Get Emgality (galcanezumab-gnlm) Covered by UnitedHealthcare in Pennsylvania: Complete Prior Authorization Guide 2025

Answer Box: Getting Emgality Covered by UnitedHealthcare in Pennsylvania Emgality (galcanezumab-gnlm) requires prior authorization from UnitedHealthcare in Pennsylvania. To get approved, you need documented failure of at least two migraine preventives (like topiramate and propranolol) and ≥4 migraine days per month. If denied, Pennsylvania's external review program overturns
7 min read

How to Get Tavneos (avacopan) Covered by UnitedHealthcare in Florida: Complete Prior Authorization Guide with Appeals Timeline

Answer Box: Getting Tavneos Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Tavneos (avacopan) in Florida, with strict criteria requiring severe active ANCA-associated vasculitis (GPA/MPA) and use alongside standard therapy. Fastest path to approval: Have your rheumatologist, nephrologist, or pulmonologist submit a PA through the UHC provider
5 min read

How Long Does It Take to Get Opfolda (Miglustat) Approved by UnitedHealthcare in Pennsylvania? Complete Timeline & Appeals Guide

Answer Box: Getting Opfolda (Miglustat) Covered by UnitedHealthcare in Pennsylvania Typical timeline: 7-14 business days for standard prior authorization through OptumRx. Fastest path: Submit both Opfolda and Pombiliti PA requests simultaneously via the UnitedHealthcare Provider Portal with complete documentation of late-onset Pompe disease diagnosis, failed enzyme replacement therapy (ERT), and
6 min read

How to Get Translarna (Ataluren) Covered by UnitedHealthcare in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Translarna Coverage Through UnitedHealthcare in Michigan Translarna (ataluren) is not FDA-approved and generally excluded by UnitedHealthcare, but coverage may be possible through formulary exceptions. Your fastest path: 1) Verify your plan type and referral needs via the member portal, 2) Have a neuromuscular specialist submit a comprehensive
6 min read