Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1121 issues

Myths vs. Facts: Getting Berinert (C1-esterase inhibitor, IV) Covered by UnitedHealthcare in Michigan

Answer Box: Getting Berinert Covered by UnitedHealthcare in Michigan Eligibility: Patients with confirmed hereditary angioedema (HAE) diagnosis via C1-esterase inhibitor testing can get Berinert covered for acute attacks. Fastest path: Submit prior authorization through OptumRx with specialist prescription, documented HAE diagnosis, and attack history. First step today: Call UnitedHealthcare at
6 min read

Do You Qualify for Evkeeza Coverage by UnitedHealthcare in New Jersey? Decision Tree & Next Steps

Answer Box: Getting Evkeeza Covered by UnitedHealthcare in New Jersey To qualify for Evkeeza (evinacumab-dgnb) coverage by UnitedHealthcare in New Jersey, you need: (1) confirmed homozygous familial hypercholesterolemia diagnosis with genetic testing or clinical criteria, (2) documented failure or intolerance to maximally tolerated statin + ezetimibe + PCSK9 inhibitor therapy, and (3)
6 min read

Lowering Out-of-Pocket Costs for Gilenya (Fingolimod) with UnitedHealthcare in Georgia: Complete Coverage and Savings Guide

Answer Box: Getting Gilenya Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Gilenya (fingolimod) through OptumRx, typically taking 7 days for approval. Essential requirements: baseline EKG and eye exam (within 30 days), vaccination records, and documentation of 2 failed MS therapies. If denied, you have 60 days for
7 min read

The Complete Guide to Getting Jynarque (Tolvaptan) Covered by UnitedHealthcare in California: Requirements, Forms & Appeal Scripts

Answer Box: Getting Jynarque Covered by UnitedHealthcare in California Fastest path to approval: UnitedHealthcare requires prior authorization for Jynarque but has no step therapy requirement as of 2024. You need ADPKD diagnosis documentation, REMS enrollment completion, and baseline liver function tests. If denied, California's Independent Medical Review (IMR)
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Work With Your Doctor to Get Dupixent (dupilumab) Covered by UnitedHealthcare in Michigan: Complete Provider Collaboration Guide

Answer Box: Getting Dupixent Covered by UnitedHealthcare in Michigan Eligibility: Dupixent requires prior authorization through OptumRx for all indications. Fastest path: Schedule a visit with your specialist to document diagnosis severity and failed prior treatments. First step today: Call your doctor's office to request your complete treatment history
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How to Get Amondys 45 (Casimersen) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Amondys 45 Covered by UnitedHealthcare in New Jersey Eligibility: Patients with DMD and confirmed exon 45 mutation amenable to skipping, prescribed by a neurologist or DMD specialist, with baseline functional assessments and FVC ≥50% predicted. Fastest path: Submit prior authorization through UnitedHealthcare provider portal with genetic testing,
5 min read

Get Epidiolex (Cannabidiol) Covered by UnitedHealthcare in California: Prior Authorization Guide, Appeal Forms & Success Rates

Answer Box: Getting Epidiolex Covered by UnitedHealthcare in California Eligibility: Epidiolex requires prior authorization for Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex in patients 1+ years old. Fastest path: Submit PA through OptumRx with neurologist prescription, documented seizure syndrome diagnosis, and proof of 2+ failed antiseizure medications. Start today:
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Getting Lutathera Covered by UnitedHealthcare in Georgia: Prior Authorization Forms, Appeal Process, and Timeline Guide

Answer Box: Your Path to Lutathera Coverage To get Lutathera covered by UnitedHealthcare in Georgia: Submit prior authorization through your oncologist with SSTR-positive imaging (Ga-68 DOTATATE PET scan), documented GEP-NET diagnosis, and evidence of somatostatin analog use. If denied, file internal appeal within 180 days, then Georgia external review within
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How to Get Palynziq Approved by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeal Guide

Quick Answer: Getting Palynziq Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Palynziq (pegvaliase-pqpz) with specific criteria: confirmed PKU diagnosis, blood phenylalanine >600 µmol/L, failed sapropterin trial, and REMS enrollment. Submit through the UnitedHealthcare provider portal with complete clinical documentation. If denied, you have 180
6 min read