Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1132 issues

Renewing Opsumit (Macitentan) Approval with UnitedHealthcare in North Carolina: 2025 Requirements & Timeline

Answer Box: Opsumit (macitentan) renewal with UnitedHealthcare in North Carolina requires submitting updated clinical documentation 30-60 days before your current authorization expires. Key 2025 changes: OptumRx is eliminating many chronic disease reauthorizations, but Opsumit's status must be verified through your provider portal. If still required, submit WHO functional
6 min read

How to Get Jakafi (Ruxolitinib) Covered by UnitedHealthcare in Michigan: Complete Prior Authorization and Appeals Guide

Quick Answer: UnitedHealthcare requires prior authorization for Jakafi (ruxolitinib) with strict medical necessity criteria. You'll need FDA-approved diagnosis documentation, proof of failed prior therapies (like hydroxyurea for polycythemia vera), and current lab results. Submit through UHC's provider portal with comprehensive clinical documentation. If denied, you have
6 min read

How to Get Firdapse (Amifampridine) Covered by UnitedHealthcare in Michigan: Complete Prior Authorization Guide with Appeals Process

Answer Box: Getting Firdapse Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Firdapse (amifampridine) in Michigan, with no step therapy required for confirmed LEMS patients. The fastest path to approval: (1) Ensure your neurologist has documented LEMS diagnosis with P/Q-type VGCC antibodies and EMG findings, (2) Submit
6 min read

How to Get Galafold (migalastat) Covered by UnitedHealthcare in North Carolina: Requirements, Appeals, and Smart NC External Review

Answer Box: Getting Galafold Covered by UnitedHealthcare in North Carolina To get Galafold (migalastat) covered by UnitedHealthcare in North Carolina, you need: (1) confirmed Fabry disease diagnosis with amenable GLA variant documented by genetic testing, (2) specialist evaluation (nephrology, genetics, or metabolics), and (3) prior authorization submission through OptumRx with
5 min read

The Complete Requirements Checklist to Get Besponsa (Inotuzumab Ozogamicin) Covered by UnitedHealthcare in Pennsylvania

Quick Answer: Getting Besponsa Covered by UnitedHealthcare in Pennsylvania Besponsa (inotuzumab ozogamicin) requires prior authorization from UnitedHealthcare for all plan types. Your fastest path to approval: 1) Gather documentation proving CD22-positive relapsed/refractory B-cell ALL and failed prior therapies, 2) Submit PA request through UnitedHealthcare Provider Portal with complete clinical
6 min read

Renewing iLink® Corneal Cross-Linking Coverage with UnitedHealthcare in Virginia: Timeline, Documentation & Appeals Guide

Quick Answer: Renewing Your iLink® Coverage UnitedHealthcare requires annual prior authorization renewal for iLink® corneal cross-linking. Start the renewal process 4-6 weeks before your current authorization expires. You'll need updated corneal topography showing continued progression, a medical necessity letter from your ophthalmologist, and evidence of treatment response. Submit
6 min read

Lowering Out-of-Pocket Costs for Carbaglu (Carglumic Acid) with UnitedHealthcare in Georgia: Copay Assistance, Tiering, and Appeals

Answer Box: Getting Carbaglu Covered by UnitedHealthcare in Georgia Fastest path to approval: Submit prior authorization with genetic/enzyme testing confirming NAGS deficiency, elevated ammonia levels, and metabolic specialist documentation through the UHC provider portal. Cost reduction: Apply for Recordati's $0 copay program for commercial plans, request tiering
7 min read

Getting Pyrukynd (Mitapivat) Covered by UnitedHealthcare in Washington: Complete Prior Authorization and Appeals Guide

Quick Answer: Your Path to Pyrukynd Coverage UnitedHealthcare requires strict prior authorization for Pyrukynd (mitapivat) in Washington. You'll need genetic confirmation of pyruvate kinase deficiency (≥2 PKLR variants, ≥1 missense), baseline hemoglobin ≤10 g/dL, limited transfusion history, and hematologist oversight. If denied, Washington's external review
5 min read

How to Get Keppra (Levetiracetam) Covered by UnitedHealthcare in Washington: Complete Guide to Formulary Tiers, Prior Authorization & Appeals

Answer Box: Quick Path to Keppra Coverage Generic levetiracetam is typically covered as Tier 1 (preferred generic) without prior authorization on most UnitedHealthcare plans in Washington. Brand Keppra requires prior authorization and medical necessity documentation. If denied, you have 180 days to file internal appeals, then external review through Washington&
6 min read