Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1058 issues

Work With Your Doctor to Get Evkeeza (evinacumab-dgnb) Approved by UnitedHealthcare in New York: Complete Prior Authorization Guide

Answer Box: Getting Evkeeza Covered by UnitedHealthcare in New York Evkeeza (evinacumab-dgnb) requires prior authorization from UnitedHealthcare for homozygous familial hypercholesterolemia (HoFH) patients ≥5 years old. Fastest path: Work with your specialist to submit a complete PA request including genetic confirmation of HoFH, documented failure of maximally tolerated therapy (statin

Denied for Fintepla (Fenfluramine) by UnitedHealthcare in Virginia? Complete Appeal Guide with Forms & Timelines

Answer Box: Getting Fintepla Covered by UnitedHealthcare in Virginia Fintepla (fenfluramine) requires prior authorization from UnitedHealthcare and typically must be filled through OptumRx specialty pharmacy. If denied, you have 180 days to appeal internally, then 120 days for Virginia's external review. First step today: Call the number on

Myths vs. Facts: Getting Tecentriq (Atezolizumab) Covered by UnitedHealthcare in New York

Answer Box: Getting Tecentriq Covered by UnitedHealthcare in New York Myth: If your doctor prescribes Tecentriq, UnitedHealthcare automatically covers it. Fact: UnitedHealthcare requires prior authorization (PA) for Tecentriq (HCPCS J9022) with specific documentation including PD-L1 testing, staging, and prior treatment history. In New York, you have strong appeal rights through

Work With Your Doctor to Get Arikayce Covered by UnitedHealthcare in Virginia: Complete Provider Partnership Guide

Answer Box: Your Path to Arikayce Coverage in Virginia UnitedHealthcare requires prior authorization for Arikayce (amikacin liposome inhalation) based on refractory MAC lung disease criteria: ≥6 months failed multidrug therapy with persistent positive cultures. Work with your pulmonologist or infectious disease specialist to document treatment failure, compile culture results, and

Get Cabometyx (Cabozantinib) Covered by UnitedHealthcare in New Jersey: Complete PA Guide, Appeals, and IHCAP Process

Answer Box: Getting Cabometyx Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization (PA) for Cabometyx (cabozantinib) through OptumRx for all cancer indications. Fastest path: Have your oncologist submit PA via the UnitedHealthcare Provider Portal with diagnosis confirmation, prior therapy details, and RECIST imaging. If denied, New Jersey residents

How to Get Palynziq (pegvaliase-pqpz) Covered by UnitedHealthcare in Florida: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Palynziq Covered by UnitedHealthcare in Florida UnitedHealthcare requires prior authorization for Palynziq (pegvaliase-pqpz) in Florida, managed through OptumRx specialty pharmacy. To get approved, you need: confirmed PKU diagnosis, blood phenylalanine >600 µmol/L, active phenylalanine-restricted diet, documented sapropterin trial failure, and REMS program enrollment. Your prescriber

Do You Qualify for Raxone (idebenone) Coverage by UnitedHealthcare in Texas? Decision Tree & Next Steps

Answer Box: Getting Raxone (idebenone) Covered by UnitedHealthcare in Texas Raxone (idebenone) requires prior authorization through UnitedHealthcare's OptumRx specialty pharmacy division and faces coverage challenges due to its non-FDA-approved status in the US. The fastest path to approval involves: 1) Gathering confirmed LHON diagnosis with genetic testing results,

How to Get Garadacimab (Andembry) Covered by UnitedHealthcare in North Carolina: Timeline, Appeals, and Documentation Guide

Answer Box: Getting Garadacimab Covered in North Carolina UnitedHealthcare requires prior authorization for Garadacimab (Andembry) with mandatory step therapy—you must try and fail preferred HAE prophylaxis medications first. Standard approval takes 2-3 business days via OptumRx portal; expedited reviews process within 24-72 hours for urgent cases. If denied, North

How to Get Hemlibra (emicizumab-kxwh) Covered by UnitedHealthcare in Texas: Complete PA Guide with Appeals Timeline

Quick Answer: Getting Hemlibra Approved by UnitedHealthcare in Texas UnitedHealthcare requires prior authorization for Hemlibra (emicizumab-kxwh) in Texas, with approval based on hemophilia A diagnosis and factor VIII inhibitor status (≥5 Bethesda units for inhibitor-positive patients). Your hematologist must submit documentation through the UnitedHealthcare Provider Portal within 14 days for

How to Get Evkeeza (evinacumab-dgnb) Covered by UnitedHealthcare in Washington: Complete Prior Authorization Guide

Quick Answer: Getting Evkeeza Covered in Washington Evkeeza (evinacumab-dgnb) requires prior authorization from UnitedHealthcare OptumRx with no step therapy requirements for homozygous familial hypercholesterolemia (HoFH). Submit PA documentation including HoFH diagnosis (genetic confirmation or clinical phenotype), maximally tolerated lipid-lowering therapy failures, and specialist prescription. If denied, Washington's robust