Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1058 issues

How to Get Uplizna (Inebilizumab) Covered by UnitedHealthcare in North Carolina: Prior Authorization, Appeals, and Cost Assistance

Answer Box: Getting Uplizna Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Uplizna (inebilizumab) for both AQP4-positive NMOSD and IgG4-related disease. Fastest path: Have your neurologist or rheumatologist submit PA via UHC Provider Portal with AQP4-IgG test results (for NMOSD), prior therapy failures, and medical necessity letter.
6 min read

Get Brensocatib (BRINSUPRI) Covered by UnitedHealthcare in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting BRINSUPRI Covered by UnitedHealthcare in California Brensocatib (BRINSUPRI) requires prior authorization through OptumRx for UnitedHealthcare plans in California. Coverage typically requires documented trial and failure of macrolide antibiotics, confirmed non-cystic fibrosis bronchiectasis diagnosis with ≥2 exacerbations per year, and age 12+. First step: Have your pulmonologist submit
6 min read

How to Get Vitrakvi (larotrectinib) Covered by UnitedHealthcare in Virginia: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Vitrakvi Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Vitrakvi (larotrectinib) with specific criteria: confirmed NTRK gene fusion via validated testing, metastatic or unresectable solid tumor, and no known resistance mutations. Submit through OptumRx portal with molecular pathology report, staging documentation, and oncologist notes. Decisions
5 min read

The Requirements Checklist to Get Zanzalintinib (XL092) Covered by UnitedHealthcare in Georgia: Appeals, Compassionate Use, and Clinical Trial Access

Answer Box: Getting Zanzalintinib (XL092) Covered by UnitedHealthcare in Georgia Zanzalintinib (XL092) is an investigational cancer drug not FDA-approved, making UnitedHealthcare coverage unlikely outside clinical trials. Your fastest path: 1) Apply for Exelixis's Expanded Access Program (drug provided free), 2) Submit UnitedHealthcare prior authorization for routine care costs
5 min read

How to Get Kuvan (Sapropterin) Approved by UnitedHealthcare in Virginia: Complete Prior Authorization Guide

Quick Answer: Getting Kuvan Approved by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Kuvan (sapropterin) through OptumRx, typically approving within 24-72 hours when you submit complete documentation. You'll need: confirmed PKU diagnosis (ICD-10 E70.0), recent phenylalanine levels, proof of phenylalanine-restricted diet, and metabolic specialist prescription. Submit
7 min read

How to Get Acthar Gel Approved by UnitedHealthcare in California: Prior Authorization Guide & Appeal Process

Answer Box: Getting Acthar Gel Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Acthar Gel (repository corticotropin injection) with strict medical necessity criteria limited to infantile spasms under age 2 and opsoclonus-myoclonus syndrome. Step therapy requiring documented failure of high-dose corticosteroids is mandatory for most conditions. If denied,
6 min read

How to Get Fabrazyme (Agalsidase Beta) Approved by UnitedHealthcare in Washington: 2025 Timeline & Appeal Guide

Answer Box: Getting Fabrazyme Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Fabrazyme (agalsidase beta) in Washington, typically decided within 1-3 business days for standard requests once complete documentation is received. Key requirements include genetic testing confirming Fabry disease, specialist prescription, and clinical evidence of organ involvement. If
7 min read

How to Get Cosentyx (secukinumab) Covered by UnitedHealthcare in Pennsylvania: Complete PA Guide with Appeals Process

Answer Box: Getting Cosentyx Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Cosentyx (secukinumab) with step therapy through preferred biologics first. Submit PA via the UHCprovider.com portal with diagnosis documentation, prior treatment failures, and clinical response data. If denied, Pennsylvania's new external review program overturns
6 min read

Do You Qualify for Arcalyst (rilonacept) Coverage by UnitedHealthcare in California? Decision Tree & Next Steps

Quick Answer: If you have CAPS, DIRA, or recurrent pericarditis and have failed colchicine/NSAIDs, you likely qualify for Arcalyst coverage through UnitedHealthcare in California. Submit prior authorization through your specialist with documented treatment failures. If denied, California's strong Independent Medical Review process overturns ~68% of specialty drug
4 min read