Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 617 issues

Renewing Koselugo (Selumetinib) Approval with UnitedHealthcare in Washington: 2025 Requirements & Timeline

Answer Box: Renewing Koselugo with UnitedHealthcare in Washington UnitedHealthcare requires prior authorization renewal for Koselugo (selumetinib) every 12 months for pediatric NF1 patients. Start renewal 30-60 days early with updated MRI showing stable/improved plexiform neurofibromas, specialist notes documenting continued benefit, and cardiac/eye monitoring results. Submit through the UnitedHealthcare

Lowering Out-of-Pocket for Brineura (cerliponase alfa) with UnitedHealthcare in Virginia: Copay, Tiering & Assistance

Answer Box: Getting Brineura Covered by UnitedHealthcare in Virginia Brineura (cerliponase alfa) requires prior authorization from UnitedHealthcare and is typically placed in specialty tiers with 20-40% coinsurance. Your fastest path to coverage: 1) Confirm CLN2 diagnosis with a pediatric neurologist, 2) Submit PA through UHC provider portal with all required

How to Get Uptravi (Selexipag) Covered by UnitedHealthcare in New York: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Uptravi Covered by UnitedHealthcare in New York Uptravi (selexipag) requires prior authorization from UnitedHealthcare for pulmonary arterial hypertension (PAH) patients in New York. Your fastest path to approval: 1. Confirm WHO Group I PAH diagnosis with right heart catheterization results 2. Document step therapy (failed PDE5 inhibitors

Myths vs. Facts: Getting Xyrem (Sodium Oxybate) Covered by UnitedHealthcare in California - Complete 2024 Guide

Quick Answer: Getting Xyrem Covered by UnitedHealthcare in California Yes, UnitedHealthcare covers Xyrem (sodium oxybate) in California with prior authorization. You'll need confirmed narcolepsy diagnosis, sleep study results, failed trials of stimulants/modafinil, and REMS enrollment. If denied, California's Independent Medical Review (IMR) offers strong appeal

How to Get Zolgensma Covered by UnitedHealthcare in Georgia: Prior Authorization, Appeals, and Alternative Strategies

Answer Box: Getting Zolgensma Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Zolgensma with strict medical criteria: genetic confirmation of bi-allelic SMN1 mutations, documentation of failed alternative treatments (Spinraza or Evrysdi), and prescriber expertise in SMA. If denied, you have 180 days for internal appeals and 60 days

Get Takhzyro (Lanadelumab-flyo) Covered by UnitedHealthcare in Ohio: Prior Authorization Guide and Appeal Strategies

Quick Answer: Getting Takhzyro Covered by UnitedHealthcare in Ohio Yes, Takhzyro (lanadelumab-flyo) is covered by UnitedHealthcare in Ohio, but requires prior authorization. To get approved: (1) Have your allergist/immunologist document confirmed HAE diagnosis with C1-INH lab results and attack frequency ≥1 per month, (2) Submit PA through UnitedHealthcare Provider

Do You Qualify for Mepsevii Coverage by UnitedHealthcare in Pennsylvania? Complete Decision Tree & Appeals Guide

Answer Box: Getting Mepsevii Covered by UnitedHealthcare in Pennsylvania Yes, you can get Mepsevii (vestronidase alfa-vjbk) covered by UnitedHealthcare in Pennsylvania if you have confirmed MPS VII diagnosis. UnitedHealthcare requires prior authorization but does NOT require step therapy since Mepsevii is the only FDA-approved treatment for MPS VII. First step

How to Get Pemazyre (Pemigatinib) Covered by UnitedHealthcare in Georgia: Appeals Guide and External Review Process

Quick Answer: Getting Pemazyre Covered by UnitedHealthcare in Georgia Yes, you can get Pemazyre (pemigatinib) covered by UnitedHealthcare in Georgia, but it requires prior authorization and molecular testing proof. The fastest path: 1) Ensure your doctor has documented FGFR2 fusion/rearrangement with lab reports, 2) Submit a complete prior authorization

How to Get Opdivo (Nivolumab) Covered by UnitedHealthcare in Georgia: Forms, Timelines & Appeal Scripts

Answer Box: Getting Opdivo Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Opdivo (nivolumab) in Georgia, typically placing it in a high specialty tier. The fastest path to approval: 1) Have your oncologist submit a PA request through the UnitedHealthcare Provider Portal with complete biomarker testing, pathology reports,

How to Get Tracleer (bosentan) Covered by UnitedHealthcare in California: Complete Appeals Guide with Forms and Templates

Answer Box: Getting Tracleer Covered by UnitedHealthcare in California Tracleer (bosentan) requires prior authorization from UnitedHealthcare with strict REMS program compliance, PAH specialist enrollment, and step therapy documentation. The fastest path: (1) Ensure your pulmonologist is REMS-certified, (2) gather right heart catheterization results confirming WHO Group 1 PAH, and (3)