Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1123 issues

How to Get Elaprase (idursulfase) Covered by UnitedHealthcare in Ohio: Renewal Guide, Forms, and Appeal Timeline

Answer Box: Quick Path to Elaprase Renewal UnitedHealthcare requires annual reauthorization for Elaprase (idursulfase) in Ohio. Start your renewal 60-90 days before your current approval expires. Submit updated clinical documentation showing treatment response through your provider portal, including reduced urine GAG levels, stable organ function, or improved walking capacity. If
6 min read

How to Get Increlex (mecasermin) Covered by UnitedHealthcare in Washington: Prior Authorization, Appeals & Step Therapy Exceptions

Answer Box: Getting Increlex Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Increlex (mecasermin) through OptumRx, with strict diagnostic criteria for severe primary IGF-1 deficiency. Your fastest path: (1) Have your pediatric endocrinologist submit a PA request with IGF-1 labs ≤ -3.0 SDS, growth hormone stimulation test results,
6 min read

Vitrakvi (Larotrectinib) Approval with UnitedHealthcare in Illinois: Answers to the Most Common Questions

Quick Answer: Getting Vitrakvi Covered by UnitedHealthcare in Illinois Yes, UnitedHealthcare covers Vitrakvi (larotrectinib) in Illinois, but requires prior authorization with documented NTRK gene fusion testing. The fastest path: have your oncologist submit a PA request through OptumRx with your molecular pathology report, staging documentation, and prior therapy history. If
6 min read

How to Get Rebif (Interferon Beta-1a) Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Rebif Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Rebif (interferon beta-1a) in North Carolina, typically with step therapy requirements. To get coverage, you'll need: confirmed MS diagnosis, MRI evidence of disease activity, baseline safety labs, and documentation of failed first-line therapies
7 min read

How to Get Cystadane (betaine anhydrous) Covered by UnitedHealthcare in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Cystadane Covered in Washington UnitedHealthcare requires prior authorization for Cystadane (betaine anhydrous) with strict genetic testing and vitamin co-therapy documentation. Fastest path: Submit complete PA through OptumRx with genetic confirmation, elevated homocysteine labs, and documented B6/B12/folate trials. If denied, appeal internally within 180 days, then
5 min read

Myths vs. Facts: Getting Spinraza (nusinersen) Covered by UnitedHealthcare in Washington

Answer Box: The Truth About Spinraza Coverage Myth: If your doctor prescribes Spinraza (nusinersen), UnitedHealthcare must cover it automatically. Fact: UnitedHealthcare requires prior authorization with genetic confirmation of 5q SMA, baseline motor function scores, and specialist attestation. Most denials stem from missing documentation, not medical necessity. In Washington, you have
5 min read

How to Get Kalydeco (ivacaftor) Covered by UnitedHealthcare in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Kalydeco Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Kalydeco (ivacaftor) as a Tier 5 specialty medication. The fastest path to approval involves three steps: 1) Submit genetic testing confirming an FDA-approved ivacaftor-responsive CFTR mutation, 2) Provide clinical documentation from a CF specialist confirming cystic
6 min read

How to Get Rezlidhia (Olutasidenib) Covered by UnitedHealthcare in Texas: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Rezlidhia Covered in Texas UnitedHealthcare requires prior authorization for Rezlidhia (olutasidenib) in Texas. To get approved, you'll need documented IDH1 mutation testing, confirmed relapsed/refractory AML diagnosis, and evidence of failed prior therapies. Submit through the UnitedHealthcare Provider Portal with complete medical necessity documentation. If
5 min read

How to Get Hemlibra (emicizumab-kxwh) Covered by UnitedHealthcare in Washington: Complete Prior Authorization Guide

Quick Answer: Getting Hemlibra Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Hemlibra (emicizumab-kxwh) in Washington, with approval typically taking 14 days for standard requests. Your fastest path to approval: Have your hematologist submit the PA through the UnitedHealthcare Provider Portal with complete documentation including hemophilia A diagnosis,
5 min read

HyperHEP (Hepatitis B Immune Globulin) Approval with UnitedHealthcare in Michigan: Complete Coverage Guide

Answer Box: Getting HyperHEP Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for HyperHEP (hepatitis B immune globulin) in Michigan, with step therapy often enforced. To get approved: (1) Document the hepatitis B exposure within 24 hours with CDC-compliant clinical rationale, (2) Submit PA through OptumRx with weight-based dosing
5 min read