Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1121 issues

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

How to Get Xenpozyme (olipudase alfa-rpcp) Covered by UnitedHealthcare in Illinois: PA Forms, Appeals, and State Protections

Answer Box: Getting Xenpozyme Covered by UnitedHealthcare in Illinois Fastest path to approval: Submit prior authorization through OptumRx with genetic confirmation of ASMD, baseline organ assessments, and escalation protocol. If denied, Illinois law provides strong appeal protections including 30-day external review and automatic step therapy exceptions for contraindicated drugs. First

How to Get Dupixent (dupilumab) Covered by UnitedHealthcare in Pennsylvania: Prior Authorization, Appeals, and Alternative Options

Answer Box: Getting Dupixent Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Dupixent (dupilumab) in Pennsylvania, with a 72-hour review timeline. Most approvals require documented diagnosis, prior therapy failures, and specialist prescription. If denied, you have 180 days for internal appeals, then 4 months for Pennsylvania's

Work With Your Doctor to Get Blenrep (Belantamab Mafodotin) Approved by UnitedHealthcare in Michigan: Complete Provider Collaboration Guide

Answer Box: Blenrep (belantamab mafodotin) is currently only available through GSK's compassionate use program after FDA withdrawal in 2022. UnitedHealthcare requires prior authorization for specialty oncology drugs, with 85% appeal success rates through peer-to-peer review. First step: Contact your oncologist to verify eligibility for compassionate use (4+ prior

Do You Qualify for Vimizim Coverage by UnitedHealthcare in New York? Decision Tree & Next Steps

Answer Box: Getting Vimizim Covered by UnitedHealthcare in New York You likely qualify if you have confirmed MPS IVA diagnosis with reduced GALNS enzyme activity or genetic confirmation. UnitedHealthcare requires prior authorization for Vimizim through OptumRx. First step today: Have your specialist submit a PA request with baseline functional assessments

How to Get Tegsedi (Inotersen) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization Guide

Answer Box: Getting Tegsedi Covered by UnitedHealthcare in New Jersey To get Tegsedi (inotersen) covered by UnitedHealthcare in New Jersey, you need: (1) confirmed hATTR polyneuropathy with genetic testing showing TTR mutation, (2) REMS program enrollment for both patient and prescriber, and (3) prior authorization through UnitedHealthcare's provider

How to Get Exondys 51 (Eteplirsen) Covered by UnitedHealthcare in Ohio: Complete Prior Authorization and Appeals Guide 2025

Answer Box: Getting Exondys 51 Covered by UnitedHealthcare in Ohio Quick Path to Approval: Exondys 51 (eteplirsen) requires prior authorization through UnitedHealthcare's OptumRx. You'll need genetic testing confirming exon 51 amenable DMD mutation, ambulatory status without assistive devices, and either NSAA score >17 or Time

How to Get Ocrevus (Ocrelizumab) Covered by UnitedHealthcare in Michigan: Prior Authorization Forms, Appeals, and Timeline Guide

Quick Answer: Ocrevus (ocrelizumab) requires prior authorization through UnitedHealthcare's OptumRx in Michigan. Start by confirming your MS diagnosis meets criteria (relapsing forms with failed first-line DMT, or PPMS under age 65 with EDSS ≤6.5), gather clinical documentation, and submit through your provider portal. If denied, you have

The Complete Requirements Checklist to Get Blenrep (Belantamab Mafodotin) Covered by UnitedHealthcare in North Carolina

Answer Box: Blenrep Coverage Status Blenrep (belantamab mafodotin) has been withdrawn from the U.S. market by GSK. UnitedHealthcare will deny coverage requests for commercial Blenrep because it's no longer commercially available. However, patients may access Blenrep through GSK's compassionate use program if already enrolled in

How to Get Rapivab (Peramivir) Covered by UnitedHealthcare in Virginia: Appeals Guide with Forms and Timelines

Quick Answer: Getting Rapivab Covered by UnitedHealthcare in Virginia Rapivab (peramivir) requires prior authorization from UnitedHealthcare and is often denied initially due to strict medical necessity criteria. To get coverage in Virginia: (1) Submit prior authorization through the UnitedHealthcare Provider Portal with documentation showing symptoms started within 48 hours and