Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1126 issues

How to Get Garadacimab (Andembry) Covered by UnitedHealthcare in New York: PA Requirements, Appeals, and Cost-Saving Strategies

Answer Box: Getting Garadacimab Covered by UnitedHealthcare in New York Garadacimab (Andembry) requires prior authorization from UnitedHealthcare's OptumRx with step therapy requirements. You must document failed or contraindicated HAE prophylaxis treatments before approval. First step today: Contact your HAE specialist to gather documentation of prior therapy failures and
5 min read

Myths vs. Facts: Getting Evrysdi (Risdiplam) Covered by UnitedHealthcare in Pennsylvania - Appeals Guide 2025

Answer Box: Getting Evrysdi Covered by UnitedHealthcare in Pennsylvania Eligibility: UnitedHealthcare requires prior authorization for Evrysdi with genetic confirmation of SMA, SMN2 copy documentation (2-4 copies for symptomatic patients), and baseline motor function assessments. No step therapy required, but concurrent use with Spinraza is prohibited. Fastest Path: Submit complete PA
6 min read

How to Get Signifor LAR (Pasireotide) Approved by UnitedHealthcare in Pennsylvania: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Signifor LAR Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Signifor LAR (pasireotide) through OptumRx specialty pharmacy. Key requirements: endocrinologist prescription, documented Cushing's disease diagnosis with failed/contraindicated surgery, or acromegaly with failed first-generation somatostatin analogs. Submit complete clinical documentation including labs (24-hour
6 min read

How to Get Ibrance (Palbociclib) Covered by UnitedHealthcare in Texas: Prior Authorization Guide and Appeals Process

Answer Box: Getting Ibrance Covered by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Ibrance (palbociclib) in Texas, with specific criteria for HR+/HER2- advanced breast cancer. The fastest path to approval: (1) Submit complete PA documentation showing HR+/HER2- diagnosis, intended combination with aromatase inhibitor or fulvestrant, and prior
6 min read

Renewing Cosentyx (Secukinumab) Approval with UnitedHealthcare in Texas: Documentation Guide & Timeline

Answer Box: Renewing Cosentyx with UnitedHealthcare in Texas UnitedHealthcare requires documented clinical response and specific therapy conditions for Cosentyx renewal in Texas. Submit renewal documentation 30-60 days before your current authorization expires. Key requirements: proof of positive clinical response (PASI/DLQI scores), confirmation you're not combining with other
5 min read

How to Get Cresemba (Isavuconazole) Covered by UnitedHealthcare in Pennsylvania: Appeals, Alternatives & Success Strategies

Answer Box: Getting Cresemba Covered by UnitedHealthcare in Pennsylvania Cresemba (isavuconazole) requires prior authorization from UnitedHealthcare and is typically Tier 3 with step therapy requirements. Your fastest path: 1) Try required alternatives (usually voriconazole, posaconazole, or fluconazole) first or document contraindications/failures, 2) Submit PA through OptumRx with infectious disease
5 min read

How to Get Turalio (Pexidartinib) Covered by UnitedHealthcare in Georgia: Complete Prior Authorization and Appeal Guide

Answer Box: Getting Turalio Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Turalio (pexidartinib) with specific TGCT documentation and REMS enrollment. The fastest approval path: (1) Complete REMS enrollment for both patient and prescriber, (2) Submit PA with surgical consultation notes showing surgery isn't feasible, and
5 min read

How to Get Brensocatib (BRINSUPRI) Covered by UnitedHealthcare in North Carolina: Prior Authorization Guide & Appeals Process

Answer Box: Getting Brensocatib (BRINSUPRI) Covered by UnitedHealthcare in North Carolina Eligibility: Patients 12+ with confirmed non-cystic fibrosis bronchiectasis and 2+ exacerbations requiring antibiotics in the past year. Fastest path: Submit prior authorization through UnitedHealthcare Provider Portal with pulmonologist evaluation, documented macrolide failure, and HRCT scan. First step today: Verify
6 min read

How Long Does It Take to Get Vigabatrin (Sabril) Approved by UnitedHealthcare in Georgia? Timeline & Appeal Guide

Answer Box: Vigabatrin Approval Timeline with UnitedHealthcare in Georgia Getting Vigabatrin (generic or brand Sabril) approved by UnitedHealthcare in Georgia typically takes 3-10 business days if all REMS enrollment and documentation requirements are complete. The process requires: (1) REMS program enrollment for prescriber, patient, and pharmacy, (2) baseline vision testing
6 min read

How to Get Tavalisse Covered by UnitedHealthcare in Pennsylvania: Complete PA Guide with Forms and Appeal Scripts

Answer Box: Getting Tavalisse Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization and step therapy for Tavalisse (fostamatinib) in Pennsylvania. You need a hematologist to prescribe it, documented failure of corticosteroids and a TPO receptor agonist, and platelet counts typically below 30,000/μL. Submit via the UHC Provider
4 min read