Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1119 issues

UnitedHealthcare's Coverage Criteria for Synagis (Palivizumab) in Washington: What Counts as "Medically Necessary"?

Answer Box: Getting Synagis Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for all Synagis (palivizumab) prescriptions with strict high-risk pediatric criteria. You must prove why Beyfortus (nirsevimab) isn't appropriate first. Fast track: Submit PA through the UnitedHealthcare Provider Portal with complete cardiology/pulmonology notes, birth certificate,
5 min read

Renewing Skyrizi (Risankizumab) Coverage with UnitedHealthcare in Ohio: Timeline, Documentation, and Appeal Process

Answer Box: Renewing Skyrizi Coverage in Ohio Quick Answer: Skyrizi (risankizumab) requires prior authorization renewal with UnitedHealthcare every 12 months. Submit renewal requests 30 days before expiration through the OptumRx portal or fax (1-844-403-1029). Required documentation includes positive clinical response evidence, PASI scores for psoriasis, and baseline liver function tests.
5 min read

How to Get Emflaza (Deflazacort) Covered by UnitedHealthcare in Ohio: Complete PA Guide, Appeals Timeline & Forms

Answer Box: Getting Emflaza Covered by UnitedHealthcare in Ohio Fastest path to approval: UnitedHealthcare typically requires step therapy for Emflaza (deflazacort), meaning you must first try prednisone or prednisolone and document failure, intolerance, or contraindication. Your neurologist must confirm DMD diagnosis and submit prior authorization through OptumRx with detailed clinical
6 min read

How to Get Arikayce Covered by UnitedHealthcare in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Arikayce Covered by UnitedHealthcare in Michigan Eligibility: Arikayce requires prior authorization through OptumRx for refractory MAC lung disease after ≥6 months of failed combination therapy. Fastest approval path: Submit complete PA request with documented treatment failure, culture results, and specialist oversight. First step today: Contact your pulmonologist
5 min read

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

Answer Box: Getting Tegsedi Covered by UnitedHealthcare in Pennsylvania Fastest Path: Complete FDA REMS enrollment (both patient and prescriber) → Submit prior authorization through UHC Provider Portal with genetic testing, baseline labs, and neurologist consultation → If denied, file internal appeal within 180 days → Use Pennsylvania's External Review Program (50%
6 min read

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

Answer Box: Getting Qinlock Covered by UnitedHealthcare in New York Eligibility: UnitedHealthcare requires prior authorization for Qinlock with documented failure of three prior kinase inhibitors (imatinib, sunitinib, and regorafenib) for GIST treatment. Fastest Path: Submit complete PA through OptumRx with treatment history, pathology reports, and recent imaging showing progression. Standard
5 min read

How Long Does It Take to Get Emflaza (deflazacort) Approved by UnitedHealthcare in California? Complete Timeline & Appeals Guide

Answer Box: Getting Emflaza Approved by UnitedHealthcare in California Timeline: 7-14 days for standard prior authorization, 2-3 days for expedited requests. Requirements: DMD diagnosis and documented failure/intolerance to prednisone or prednisolone (step therapy). First step: Have your neurologist submit prior authorization through the UnitedHealthcare provider portal with complete DMD
4 min read