Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 116 issues

If Ultomiris (Ravulizumab) Isn't Approved by UnitedHealthcare in Michigan: Formulary Alternatives & Exception Strategies

Quick Answer: Your Options When Ultomiris Is Denied If UnitedHealthcare denies Ultomiris (ravulizumab) in Michigan, you have three main paths: try a formulary alternative like Soliris (eculizumab), request a formulary exception with medical necessity documentation, or pursue a formal appeal. Your fastest option is often requesting a peer-to-peer review where
6 min read

Coding That Helps Get Orkambi (Lumacaftor/Ivacaftor) Approved by UnitedHealthcare in Florida: ICD-10, HCPCS, and NDC Requirements

Answer Box: Quick Path to Orkambi Coverage Getting Orkambi (lumacaftor/ivacaftor) covered by UnitedHealthcare in Florida requires specific coding and documentation. Use ICD-10 code E84.0-E84.9 for cystic fibrosis manifestations, submit genetic testing confirming F508del homozygous status, and ensure a CF specialist prescribes the medication. Submit prior authorization through
6 min read

Renewing Fabrazyme (Agalsidase Beta) Approval with UnitedHealthcare in Michigan: 2025 Requirements and Timeline

Answer Box: Renewing Fabrazyme with UnitedHealthcare in Michigan Fabrazyme requires annual reauthorization with UnitedHealthcare, typically 12 months after initial approval. Start the renewal process 30 days before expiration to avoid coverage gaps. Submit updated clinical documentation showing treatment response through your provider's UnitedHealthcare portal or OptumRx system. If
5 min read

UnitedHealthcare's Coverage Criteria for Gattex (Teduglutide) in Pennsylvania: What Counts as "Medically Necessary"?

Answer Box: Getting Gattex Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Gattex (teduglutide) with strict medical necessity criteria: documented short bowel syndrome, 12+ months of parenteral nutrition dependence (≥3 days/week), failed enteral optimization attempts, and recent colonoscopy with polyp removal. Fastest path to approval: Submit complete
6 min read

How to Get Orladeyo (Berotralstat) Covered by UnitedHealthcare in New Jersey: Complete Guide with Forms and Appeal Templates

Answer Box: Getting Orladeyo Covered by UnitedHealthcare in New Jersey Orladeyo (berotralstat) requires prior authorization from UnitedHealthcare in New Jersey. To get approved: 1. Visit an HAE specialist (allergist/immunologist) who can document your hereditary angioedema diagnosis with C1-INH testing and attack frequency 2. Submit prior authorization through the UnitedHealthcare
6 min read

Getting Jaypirca (Pirtobrutinib) Approved by UnitedHealthcare in Virginia: Complete Guide to Coverage, Appeals, and Forms

Answer Box: Fast Track to Jaypirca Coverage in Virginia Getting Jaypirca (pirtobrutinib) approved by UnitedHealthcare in Virginia requires prior authorization and documentation of failed BTK inhibitor therapy. The fastest path: 1) Gather records of prior BTK inhibitor treatment (ibrutinib, acalabrutinib, or zanubrutinib) and failure/intolerance, 2) Submit complete prior authorization
5 min read

How to Get Venclexta (venetoclax) Covered by UnitedHealthcare in California: Prior Authorization Guide & Appeal Scripts

Quick Answer: Getting Venclexta Covered by UnitedHealthcare in California Venclexta (venetoclax) requires prior authorization from UnitedHealthcare for CLL, AML, and other approved blood cancers. The fastest path: Your oncologist submits PA documentation showing your diagnosis, tumor lysis syndrome monitoring plan, and any required prior therapies. If denied, California's
5 min read

UnitedHealthcare's Coverage Criteria for Keytruda in Washington: What Counts as "Medically Necessary"?

Answer Box: Getting Keytruda Covered by UnitedHealthcare in Washington To get Keytruda (pembrolizumab) covered by UnitedHealthcare in Washington, you need prior authorization with specific biomarker testing results (PD-L1 CPS ≥1, MSI-H, or TMB-H ≥10 mutations/megabase for most indications). Submit through the UnitedHealthcare Provider Portal with complete pathology reports, clinical
6 min read