Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1120 issues

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

Hetlioz (Tasimelteon) Approval with UnitedHealthcare in Ohio: Complete Coverage Guide and Appeal Process

Answer Box: Getting Hetlioz Covered by UnitedHealthcare in Ohio Hetlioz (tasimelteon) requires prior authorization from UnitedHealthcare through OptumRx for all plan types in Ohio. Your sleep specialist must submit documentation including genetic testing results (17p11.2 deletion or RAI1 mutation), documented sleep disturbances, and prior treatment history. Standard approval takes
6 min read

Get Tavalisse (fostamatinib) Covered by UnitedHealthcare in Virginia: Complete Prior Authorization Guide with Forms and Appeal Process

Answer Box: Getting Tavalisse Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Tavalisse (fostamatinib) through OptumRx, with mandatory step therapy documentation showing failure of corticosteroids and thrombopoietin receptor agonists. Submit requests via the UnitedHealthcare Provider Portal with complete clinical documentation. If denied, Virginia offers a robust external review
6 min read

How to Get Orladeyo (berotralstat) Covered by UnitedHealthcare in Pennsylvania: Complete Guide to Prior Authorization, Appeals, and State Protections

Quick Answer: Getting Orladeyo Covered in Pennsylvania Fast track to approval: Submit prior authorization through UnitedHealthcare's provider portal with complete HAE diagnosis documentation, C1-INH lab results, and evidence of failed/contraindicated injectable therapies. If denied, you have 180 days for internal appeals, then 4 months for Pennsylvania'
6 min read

Lowering Out-of-Pocket Costs for Tecentriq (Atezolizumab) with UnitedHealthcare in Washington: Complete Coverage and Savings Guide

Answer Box: Getting Tecentriq Covered in Washington Fastest Path: Tecentriq requires prior authorization through UnitedHealthcare's medical benefit (not pharmacy). Submit PA with complete biomarker testing, staging, and treatment history through the UnitedHealthcare Provider Portal. If denied, file internal appeal within 180 days, then external review with Washington'
7 min read

Lowering Out-of-Pocket Costs for Fintepla with UnitedHealthcare in Pennsylvania: Complete Copay, Tiering & Financial Assistance Guide

Answer Box: Getting Fintepla Covered by UnitedHealthcare in Pennsylvania Fintepla (fenfluramine) requires prior authorization from UnitedHealthcare and is placed on Specialty Tier 5 with high out-of-pocket costs. To minimize expenses: 1) Apply for UCB's ONWARD Copay Assistance Program (can reduce copays to $0-$25 for commercial insurance), 2)
5 min read

How to Get Amondys 45 (Casimersen) Covered by UnitedHealthcare in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Amondys 45 Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Amondys 45 (casimersen) through OptumRx. To qualify, you need confirmed DMD with exon 45 mutation, baseline 6MWT ≥300 meters, and no prior gene therapy. First step today: Contact your neurologist to request genetic testing confirmation
5 min read

How to Get Keytruda (Pembrolizumab) Approved by UnitedHealthcare in Pennsylvania: Complete Timeline and Appeals Guide

Quick Answer: Getting Keytruda Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Keytruda (pembrolizumab) in Pennsylvania, typically taking 5-14 business days for standard review. You'll need biomarker testing (PD-L1, MSI-H, or TMB-H), complete staging documentation, and evidence of medical necessity aligned with NCCN guidelines. If denied,
5 min read

Myths vs. Facts: Getting Exondys 51 (Eteplirsen) Covered by UnitedHealthcare in Illinois - Appeals Guide

Answer Box: Fast Track to Exondys 51 Coverage in Illinois Eligibility: Patients with confirmed DMD and exon 51-amenable mutations can get UnitedHealthcare coverage through proper documentation. Fastest path: Submit prior authorization through UnitedHealthcare's electronic portal with genetic testing, neurologist evaluation, and functional assessments. Start today: Contact your neurologist
5 min read