Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1121 issues

How to Get Qalsody (Tofersen) Covered by UnitedHealthcare in North Carolina: Prior Authorization, Appeals, and State Review Guide

Answer Box: Getting Qalsody Covered by UnitedHealthcare in North Carolina Eligibility: UnitedHealthcare covers Qalsody (tofersen) for ALS patients with confirmed SOD1 mutations, but requires prior authorization through OptumRx. The medication sits on Specialty Tier with 30-50% coinsurance. Fastest Path: 1) Gather SOD1 genetic test results and baseline ALSFRS-R scores, 2)
6 min read

The Complete Requirements Checklist to Get Advate (octocog alfa) Covered by UnitedHealthcare in Pennsylvania

Answer Box: Get Advate Covered by UnitedHealthcare in Pennsylvania Advate (octocog alfa) requires prior authorization through UnitedHealthcare's OptumRx and typically faces step therapy requirements. To get approved: (1) Submit PA with comprehensive hemophilia A documentation including factor VIII levels, inhibitor testing, and prior treatment failures; (2) If denied,
5 min read

UnitedHealthcare's Coverage Criteria for Vyndaqel/Vyndamax (Tafamidis) in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Vyndaqel/Vyndamax Covered by UnitedHealthcare in Washington Fastest path to approval: Submit prior authorization with confirmed ATTR-CM diagnosis (PYP scan grade 2/3 or biopsy), NYHA Class I-III status, and negative light chain testing. UnitedHealthcare requires cardiology oversight and 12-month reauthorization. If denied, you have 60 days
5 min read

How to Get Poteligeo (mogamulizumab-kpkc) Covered by UnitedHealthcare in New Jersey: Prior Authorization, Appeals, and State Protections Guide

Answer Box: Getting Poteligeo Covered by UnitedHealthcare in New Jersey Fastest Path to Approval: Poteligeo (mogamulizumab-kpkc) requires prior authorization from UnitedHealthcare through OptumRx for mycosis fungoides or Sézary syndrome. Submit your request through the UnitedHealthcare Provider Portal with complete pathology reports, staging workup, and documented failure of at least one
8 min read

How to Get Eylea and Lucentis Covered by UnitedHealthcare in Georgia: Prior Authorization Guide and Appeal Process

Answer Box: Get Eylea or Lucentis Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for both Eylea and Lucentis in Georgia. Your retina specialist must submit documentation including diagnosis codes, OCT imaging, visual acuity measurements, and evidence of bevacizumab trial or contraindication. First step today: Contact your eye doctor
6 min read

Myths vs. Facts: Getting Ozempic and Mounjaro Covered by UnitedHealthcare in Illinois (2025 Appeal Guide)

Quick Answer: What Really Gets Ozempic/Mounjaro Covered by UnitedHealthcare in Illinois The Reality: UnitedHealthcare requires prior authorization for both Ozempic and Mounjaro, covering them primarily for FDA-approved diabetes indications—not automatic weight loss coverage. In Illinois, you have strong appeal rights including external review within 30 days of denial.
6 min read

Work With Your Doctor to Get Xenpozyme (olipudase alfa-rpcp) Approved by UnitedHealthcare in Georgia: Complete Provider Collaboration Guide

Answer Box: Getting Xenpozyme Covered by UnitedHealthcare in Georgia To get Xenpozyme (olipudase alfa-rpcp) approved by UnitedHealthcare in Georgia, you'll need: confirmed ASMD diagnosis with genetic testing and enzyme assay, prior authorization through your doctor, and a medical necessity letter documenting failed treatments and functional impact. If denied,
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UnitedHealthcare's Coverage Criteria for Darzalex (Daratumumab) in North Carolina: Complete Medical Necessity Guide

Answer Box: Getting Darzalex Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Darzalex (daratumumab) with specific medical necessity criteria: confirmed multiple myeloma diagnosis, appropriate treatment line documentation, and FDA-approved or NCCN guideline-supported regimens. Submit PA requests through the UnitedHealthcare Provider Portal with complete clinical documentation. If denied,
6 min read