Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 118 issues

Tegsedi (Inotersen) Approval with UnitedHealthcare in Georgia: Answers to the Most Common Questions

Answer Box: Getting Tegsedi Covered by UnitedHealthcare in Georgia Yes, UnitedHealthcare covers Tegsedi (inotersen) for hereditary transthyretin-mediated (hATTR) amyloidosis with polyneuropathy in adults, but requires prior authorization. The fastest path to approval: (1) Enroll in the Tegsedi REMS program immediately, (2) Document genetic TTR mutation and prior Onpattro trial/failure,
5 min read

Do You Qualify for Enhertu Coverage by UnitedHealthcare in Georgia? Decision Tree & Next Steps

Answer Box: Your Path to Enhertu Coverage in Georgia UnitedHealthcare requires prior authorization for Enhertu (fam-trastuzumab deruxtecan) in Georgia. To qualify, you need documented HER2-positive status, appropriate diagnosis (breast, lung, or gastric cancer), and typically evidence of prior HER2-targeted therapy failure. Submit requests through the UnitedHealthcare Provider Portal with complete
5 min read

How to Get Ilaris (Canakinumab) Approved by UnitedHealthcare in California: Timeline, Appeals & Success Strategies

Quick Answer: Getting Ilaris Approved by UnitedHealthcare in California Yes, UnitedHealthcare covers Ilaris (canakinumab) with prior authorization for FDA-approved conditions including Still's disease, periodic fever syndromes, and refractory gout. The fastest path: Have your rheumatologist submit a complete PA request through the UnitedHealthcare provider portal with documented step
7 min read

How to Get Raxone (Idebenone) Covered by UnitedHealthcare in Pennsylvania: Prior Authorization, Appeals & Cost-Saving Strategies

Quick Answer: Raxone (idebenone) is not FDA-approved in the U.S., making UnitedHealthcare coverage extremely difficult. However, you can pursue coverage through: (1) Prior authorization with medical necessity documentation for off-label use, (2) Step therapy exceptions if alternatives failed, and (3) Pennsylvania's external review process, which overturns ~50%
6 min read

How to Get Mepsevii (Vestronidase Alfa-vjbk) Covered by UnitedHealthcare in California: Complete Prior Authorization Guide

Quick Answer: Getting Mepsevii Covered in California UnitedHealthcare requires prior authorization for Mepsevii (vestronidase alfa-vjbk) in California. To get approved: (1) Submit a PA request through the UnitedHealthcare provider portal with confirmed MPS VII diagnosis (enzyme/genetic testing), (2) Include specialist documentation and ICD-10 code E76.2, (3) If denied,
7 min read

The Complete Guide to Getting Rezlidhia (Olutasidenib) Covered by UnitedHealthcare in New Jersey: Requirements, Appeals, and Step Therapy

Answer Box: Getting Rezlidhia Covered in New Jersey UnitedHealthcare requires prior authorization for Rezlidhia (olutasidenib) in New Jersey, with specific requirements for documented IDH1 mutation and AML diagnosis. The fastest path: (1) Submit PA through the UnitedHealthcare Provider Portal with IDH1 mutation test results, (2) Include medical necessity letter addressing
5 min read

How to Get Tegsedi (Inotersen) Covered by UnitedHealthcare in North Carolina: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Tegsedi Covered by UnitedHealthcare in North Carolina Eligibility: Adults with confirmed hATTR polyneuropathy and documented TTR gene mutation. Fastest path: Complete REMS enrollment, document step therapy failure (typically Onpattro), and submit comprehensive prior authorization through UnitedHealthcare Provider Portal. First step today: Contact your neurologist to verify genetic
6 min read

How to Get Nourianz (Istradefylline) Approved by UnitedHealthcare in Ohio: Timeline, Appeals, and Documentation Requirements

Answer Box: Getting Nourianz Covered in Ohio UnitedHealthcare requires prior authorization for Nourianz (istradefylline) in Ohio, typically taking 29 seconds to several days depending on documentation completeness. Step 1: Ensure you've tried required alternatives (amantadine, MAO-B inhibitors, COMT inhibitors) or have medical contraindications documented. Step 2: Your doctor
6 min read

How to Get Taltz (Ixekizumab) Covered by UnitedHealthcare in Georgia: Prior Authorization Guide with Appeals Process

Answer Box: Getting Taltz Covered by UnitedHealthcare in Georgia UnitedHealthcare requires prior authorization for Taltz (ixekizumab) with documented step therapy and TB screening. Fastest approval path: Have your dermatologist or rheumatologist submit a PA request with diagnosis codes (L40.0 for plaque psoriasis, M07.0-M07.3 for psoriatic arthritis), proof
6 min read