Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1106 issues

How to Get Zolgensma Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Zolgensma Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization through OptumRx for Zolgensma (onasemnogene abeparvovec-xioi) with strict clinical criteria: genetic confirmation of bi-allelic SMN1 mutations, age under 2 years, anti-AAV9 antibody titer ≤1:50, and documented steroid protocol. If denied, North Carolina residents can appeal
7 min read

Xyrem (Sodium Oxybate) Approval with UnitedHealthcare in Georgia: Answers to the Most Common Questions

Answer Box: Getting Xyrem Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Xyrem (sodium oxybate) in Georgia, with strict step-therapy requirements including trials of modafinil, armodafinil, and other wake-promoting agents. The fastest path: (1) Complete REMS enrollment at XywavXyremREMS.com, (2) Submit PA via UnitedHealthcare provider portal with
5 min read

Do You Qualify for Darzalex Coverage by UnitedHealthcare in New York? Complete Decision Tree & Appeals Guide

Answer Box: Your Path to Darzalex Coverage UnitedHealthcare requires prior authorization for Darzalex/Darzalex Faspro in New York, with coverage tied to FDA-approved indications and NCCN guidelines. Most likely eligible: confirmed multiple myeloma with specialist prescribing and documented treatment line. First step today: Have your oncologist gather pathology reports, prior
5 min read

Getting StrataGraft Covered by UnitedHealthcare in Texas: Prior Authorization Guide, Appeals Process, and Alternative Options

Answer Box: Getting StrataGraft Covered in Texas StrataGraft requires prior authorization from UnitedHealthcare as a medical benefit (not pharmacy). Submit PA through the UHC Provider Portal with burn depth documentation, TBSA calculations, and clinical justification that autografting would otherwise be needed. Standard decisions take 5-15 business days; expedited reviews (24-72
6 min read

How to Get Sumavel DosePro (Sumatriptan Injection, Needle-Free) Covered by UnitedHealthcare in Washington: Prior Authorization Guide, Appeals Process, and State Protection Rights

Answer Box: Fast Track to Approval Sumavel DosePro (needle-free sumatriptan injection) is discontinued but generic auto-injectors require UnitedHealthcare prior authorization with step therapy to oral triptans first. Washington residents have strong appeal rights through Independent Review Organizations (IROs) after internal denials. Start today: (1) Request step therapy exception if oral
7 min read

How to Get Gattex (Teduglutide) Covered by UnitedHealthcare in California: Appeals, Forms & Timelines

Answer Box: Getting Gattex Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Gattex (teduglutide) with strict medical necessity criteria: documented short bowel syndrome, ≥12 months of parenteral nutrition dependence (≥3 days/week), recent colonoscopy, and specialist involvement. If denied, California residents can appeal internally, then request an Independent
6 min read

How to Get Xywav Covered by UnitedHealthcare in Washington: Complete PA Guide & Appeal Steps

Answer Box: Getting Xywav Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Xywav (calcium-magnesium-potassium-sodium oxybates) with specific medical documentation and REMS enrollment. The fastest path: (1) Complete REMS enrollment at XYWAVXYREMREMS.com, (2) Submit PA via UHC provider portal with sleep study results and prior therapy documentation, (3)
6 min read

How to Get Brineura (cerliponase alfa) Covered by UnitedHealthcare in New York: Complete Appeals Guide with Forms and Deadlines

Answer Box: Getting Brineura Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Brineura (cerliponase alfa) with strict clinical criteria: confirmed CLN2 diagnosis, age ≥3 years, baseline motor/language scores ≥1, and treatment at a qualified neurosurgical center. If denied, you have 180 days for internal appeals, then
6 min read