Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1118 issues

How to Get Jynarque (tolvaptan) Covered by UnitedHealthcare in Washington: Complete PA Guide with Appeal Scripts

Answer Box: Getting Jynarque Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Jynarque (tolvaptan) but typically no step therapy for ADPKD patients. Key requirements: confirmed ADPKD diagnosis, evidence of rapid progression (Mayo class 1C-1E or eGFR decline ≥3 mL/min/1.73 m²/year), REMS enrollment, and baseline

How to Get Hemgenix (etranacogene dezaparvovec) Covered by UnitedHealthcare in Florida: Complete Prior Authorization Guide

Answer Box: Getting Hemgenix Covered by UnitedHealthcare in Florida Quick Path to Approval: UnitedHealthcare requires prior authorization for Hemgenix (etranacogene dezaparvovec) through OptumRx, with decisions typically within 72 hours for standard requests. You'll need documented severe hemophilia B, prior factor therapy history, and treatment at a federally designated

How to Get Carbaglu (Carglumic Acid) Covered by UnitedHealthcare in Michigan: Complete Guide to Prior Authorization, Appeals, and State Protections

Answer Box: Quick Path to Carbaglu Coverage Getting Carbaglu (carglumic acid) covered by UnitedHealthcare in Michigan requires prior authorization through OptumRx. Your fastest path: 1) Have your metabolic specialist submit a complete PA request with NAGS deficiency diagnosis, genetic testing, and ammonia levels via the UHC provider portal, 2) If

Work With Your Doctor to Get Berinert Covered by UnitedHealthcare in California: Provider Partnership Guide

Answer Box: Getting Berinert Covered by UnitedHealthcare in California Fast track to approval: Schedule a visit with an allergist or immunologist to document your HAE diagnosis, attack frequency, and failed treatments. Request they submit a medical necessity letter emphasizing FDA-approved indication and prior therapy failures. If denied, file an internal

How to Get Imbruvica (ibrutinib) Covered by UnitedHealthcare in New York: Complete PA Guide and Appeals Process

Answer Box: Getting Imbruvica Approved by UnitedHealthcare in New York UnitedHealthcare requires prior authorization (PA) for all Imbruvica prescriptions in New York, with the drug placed on Tier 3 (specialty, non-preferred) status. The fastest path to approval: (1) Submit a complete PA through the UnitedHealthcare Provider Portal with diagnosis confirmation,

How to Get Chenodal (chenodiol) Covered by UnitedHealthcare in Georgia: Complete Timeline & Appeals Guide 2025

Answer Box: Getting Chenodal Covered by UnitedHealthcare in Georgia Timeline: 72 hours to 7 days for standard prior authorization through OptumRx; 24-48 hours if marked urgent. Requirements: Radiolucent cholesterol gallstones, well-opacifying gallbladder, surgical ineligibility, and failed ursodiol trial ≥6 months. First step: Have your prescriber submit PA electronically via UnitedHealthcare

Do You Qualify for Daybue (trofinetide) Coverage by UnitedHealthcare in California? Decision Tree & Next Steps

Answer Box: To get Daybue (trofinetide) covered by UnitedHealthcare in California, you need: (1) confirmed Rett syndrome diagnosis with MECP2 testing, (2) patient age ≥2 years, and (3) specialist attestation from neurology or genetics. Submit prior authorization through the UHC Provider Portal with clinical documentation. If denied, file internal appeal

Getting Voydeya (Danicopan) Covered by UnitedHealthcare in Washington: Renewal Timeline, Appeals Process, and Required Documentation

Answer Box: Getting Voydeya Covered by UnitedHealthcare in Washington Voydeya (danicopan) requires prior authorization through UnitedHealthcare's OptumRx with annual renewal requirements. Start renewal 4-6 weeks early with updated labs (hemoglobin, LDH, reticulocyte count), transfusion records, and specialist documentation of ongoing benefit. If denied, Washington allows internal appeals (180

UnitedHealthcare's Coverage Criteria for Bavencio (avelumab) in Florida: What Counts as "Medically Necessary"?

Answer Box: Getting Bavencio Covered by UnitedHealthcare in Florida To get Bavencio (avelumab) approved by UnitedHealthcare in Florida: Submit prior authorization through the UHC Provider Portal with pathology report, staging imaging, and complete treatment history. For Merkel cell carcinoma, no step therapy is required. For urothelial carcinoma maintenance, document completion

How to Get Oxervate (Cenegermin) Covered by UnitedHealthcare in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Get Oxervate Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Oxervate (cenegermin) with specific criteria: confirmed Stage 2 or 3 neurotrophic keratitis diagnosis and documented failure of at least one OTC artificial tear product. Submit PA through the OptumRx portal or fax to 1-844-403-1027. If