Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1119 issues

How to Get Synagis (Palivizumab) Covered by UnitedHealthcare in Michigan: Complete Authorization Guide

Answer Box: Getting Synagis Covered by UnitedHealthcare in Michigan UnitedHealthcare covers Synagis (palivizumab) for high-risk infants in Michigan through prior authorization via OptumRx. Call 1-800-310-6826 for prior notification. You'll need cardiology or pulmonology documentation proving your child meets strict criteria: prematurity with chronic lung disease, hemodynamically significant congenital
7 min read

Do You Qualify for Takhzyro Coverage by UnitedHealthcare in Virginia? Decision Tree & Next Steps

Answer Box: Getting Takhzyro Covered by UnitedHealthcare in Virginia You likely qualify for Takhzyro (lanadelumab-flyo) coverage if you have confirmed hereditary angioedema (HAE) with documented C1-INH deficiency and ≥1 attack per month. UnitedHealthcare requires prior authorization through OptumRx with specific lab values and attack documentation. The fastest path: Have your
6 min read

How to Get Strensiq (Asfotase Alfa) Covered by UnitedHealthcare in Michigan: Complete PA Guide, Appeals Timeline & Approval Scripts

Quick Answer: Getting Strensiq Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Strensiq (asfotase alfa) with strict clinical criteria: documented perinatal/infantile or juvenile-onset hypophosphatasia, low alkaline phosphatase levels, ALPL mutation or elevated TNSALP substrates, and prescribing by a specialist. Start by confirming your plan's formulary
5 min read

How Long Does It Take to Get Amvuttra (vutrisiran) Approved by UnitedHealthcare in Ohio? Complete Timeline & Appeals Guide

Answer Box: Getting Amvuttra Approved by UnitedHealthcare in Ohio UnitedHealthcare typically takes 15 business days for standard Amvuttra prior authorization review, or 72 hours for expedited requests. The fastest path: have your specialist submit complete documentation (genetic testing, diagnosis confirmation, prior therapy records) via the UnitedHealthcare Provider Portal. If denied,
5 min read

Work With Your Doctor to Get Acthar Gel Approved by UnitedHealthcare in Pennsylvania: Complete Provider Collaboration Guide

Answer Box: Fast Track to Acthar Gel Approval Getting Acthar Gel covered by UnitedHealthcare in Pennsylvania requires strong provider partnership. Your doctor must submit prior authorization showing failed corticosteroids and medical necessity for your specific condition (infantile spasms, MS exacerbation, or other labeled indication). If denied, you have internal appeals
6 min read

Myths vs. Facts: Getting Amondys 45 (casimersen) Covered by UnitedHealthcare in Illinois - Complete Prior Authorization and Appeals Guide

Answer Box: Getting Amondys 45 (casimersen) Covered by UnitedHealthcare in Illinois Key Facts: UnitedHealthcare requires prior authorization for Amondys 45 with genetic testing proving exon 45-amenable DMD mutation. Illinois residents have strong appeal rights including external review within 4 months of denial. Fastest path: Submit complete PA packet with genetic
6 min read

Get Takhzyro (Lanadelumab-flyo) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization Guide with Forms and Appeal Scripts

Answer Box: Getting Takhzyro Approved by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Takhzyro (lanadelumab-flyo) with specific criteria: confirmed HAE diagnosis with C1-INH deficiency, baseline attack rate ≥1 per 4 weeks, and prescribing by an allergist/immunologist. Submit through the UnitedHealthcare Provider Portal with lab results, attack documentation,
6 min read

How to Get Bylvay (odevixibat) Covered by UnitedHealthcare in Pennsylvania: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Bylvay Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Bylvay (odevixibat) in Pennsylvania, with two different policy tracks depending on your specific plan. Most plans require documented failure of at least two conventional cholestatic pruritus treatments and specialist prescribing. If denied, you have 180 days
6 min read

How to Get Vyndaqel/Vyndamax (Tafamidis) Covered by UnitedHealthcare in Michigan: Complete Guide to Forms, Appeals & Approval

Answer Box: Getting Tafamidis Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Vyndaqel/Vyndamax (tafamidis) in Michigan, with approval based on confirmed ATTR-CM diagnosis, NYHA Class I-III heart failure, and cardiology oversight. Fastest path: Have your cardiologist submit PA through the UHC Provider Portal with complete diagnostic documentation.
6 min read

How to Get Sumatriptan Injection Covered by UnitedHealthcare in Illinois: Prior Authorization, Appeals & Step Therapy Guide

Quick Answer: Getting Sumatriptan Injection Covered by UnitedHealthcare in Illinois Note: Sumavel DosePro (needle-free) was discontinued in the U.S. UnitedHealthcare now covers generic sumatriptan injection products (auto-injector pens, prefilled syringes) typically on Tier 1 with prior authorization required. To get coverage: 1) Have your doctor document migraine/cluster headache
6 min read