Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1133 issues

How to Get Poteligeo (mogamulizumab-kpkc) Covered by UnitedHealthcare in New York: Prior Authorization, Appeals & Step Therapy Guide

Answer Box: Getting Poteligeo Covered by UnitedHealthcare in New York Poteligeo (mogamulizumab-kpkc) requires prior authorization from UnitedHealthcare for mycosis fungoides or Sézary syndrome treatment. You'll need documented failure of at least one prior systemic therapy and prescribing by a hematologist or oncologist. First step: Gather your CTCL staging

Get Mavenclad (Cladribine Tablets) Covered by UnitedHealthcare in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Mavenclad Covered by UnitedHealthcare in Texas Yes, Mavenclad (cladribine tablets) is covered by UnitedHealthcare in Texas, but requires prior authorization through OptumRx and step therapy documentation. Your neurologist must prove you've tried and failed (or can't tolerate) at least one other MS disease-modifying

Oxbryta (Voxelotor) Coverage by UnitedHealthcare in Florida: Understanding the 2024 FDA Withdrawal and Your Options

Answer Box: Oxbryta Coverage Status Oxbryta (voxelotor) was voluntarily withdrawn from all U.S. markets in September 2024 due to increased risk of vaso-occlusive crises and deaths. UnitedHealthcare and all insurers have delisted the medication—no new claims or renewals are being approved. If you're currently taking Oxbryta,

Getting Symdeko/Symkevi Covered by UnitedHealthcare in Florida: Complete Prior Authorization Guide

Answer Box: Fastest Path to Approval Symdeko/Symkevi requires prior authorization from UnitedHealthcare in Florida. To get approved: (1) Have your CF specialist submit a PA request with genotype documentation showing F508del mutation via UnitedHealthcare's Provider Portal, (2) Include a medical necessity letter detailing your CF diagnosis and

How to Get Carbaglu (Carglumic Acid) Covered by UnitedHealthcare in Virginia: Complete PA Guide with Appeals Process

Quick Answer: Getting Carbaglu Covered by UnitedHealthcare in Virginia Yes, you can get Carbaglu (carglumic acid) covered by UnitedHealthcare in Virginia if you have confirmed NAGS deficiency. UnitedHealthcare requires prior authorization with genetic/enzyme testing, elevated ammonia levels, and specialist documentation. If denied, Virginia's external review process via

Getting Elfabrio (Pegunigalsidase Alfa-iwxj) Covered by UnitedHealthcare in Ohio: Coding, Prior Authorization, and Appeals Guide

Answer Box: Getting Elfabrio Covered by UnitedHealthcare in Ohio Elfabrio (pegunigalsidase alfa-iwxj) requires prior authorization through UnitedHealthcare/OptumRx for Fabry disease patients in Ohio. Use ICD-10 code E75.21, HCPCS J2508 (1 mg billing units), and 11-digit NDCs. Submit genetic testing or enzyme assay results confirming Fabry disease diagnosis via

How to Get Besponsa (Inotuzumab Ozogamicin) Covered by UnitedHealthcare in Virginia: Complete Guide to Prior Authorization, Appeals, and State Protections

Answer Box: Getting Besponsa Covered in Virginia Besponsa (inotuzumab ozogamicin) requires prior authorization from UnitedHealthcare in Virginia. Your oncologist must document CD22-positive B-cell ALL, failed prior chemotherapy, and a hepatic monitoring plan. If denied, Virginia offers strong consumer protections: you can appeal internally (180 days), then request external review through

UnitedHealthcare's Coverage Criteria for Mycapssa (Octreotide, Oral) in Illinois: What Counts as "Medically Necessary"?

Answer Box: Getting Mycapssa Covered by UnitedHealthcare in Illinois To get Mycapssa (oral octreotide) approved by UnitedHealthcare in Illinois, you must meet all of these criteria: confirmed acromegaly diagnosis with elevated IGF-1 or GH levels, documented prior response to injectable octreotide or lanreotide, clinical justification for switching to oral therapy,

Lowering Out-of-Pocket Costs for Jynarque (Tolvaptan) with UnitedHealthcare in Pennsylvania: Complete Copay and Appeals Guide

Answer Box: Getting Jynarque Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Jynarque (tolvaptan) but has no step therapy requirement. Commercially insured patients can access Otsuka's copay program for as little as $10/month (up to $8,000 annually). If denied, Pennsylvania's new external

How to Get Givlaari (Givosiran) Covered by UnitedHealthcare in Florida: Complete Prior Authorization Guide

Answer Box: Getting Givlaari Covered by UnitedHealthcare in Florida To get Givlaari (givosiran) covered by UnitedHealthcare in Florida, you must document acute hepatic porphyria with at least 2 qualifying attacks in the past 6 months, show failure/intolerance to hemin therapy, and obtain specialist prescribing. Submit prior authorization through the