Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1133 issues

How to Get Firazyr (Icatibant) Covered by UnitedHealthcare in California: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Firazyr Covered by UnitedHealthcare in California Firazyr (icatibant) requires strict prior authorization from UnitedHealthcare for hereditary angioedema (HAE) treatment. You'll need confirmed HAE diagnosis (ICD-10: D84.1), specialist prescription, documented failure of preferred alternatives (like Berinert), and self-administration training proof. Generic icatibant is typically covered

How Long Does It Take to Get Kalydeco (ivacaftor) Approved by UnitedHealthcare in Michigan? Complete Timeline Guide

Quick Answer: UnitedHealthcare Kalydeco Approval Timeline in Michigan Standard timeline: 3-14 days from complete submission. UnitedHealthcare requires prior authorization for Kalydeco (ivacaftor) with CFTR genetic testing documentation. Fastest path: Submit complete OptumRx PA form with mutation test results through provider portal. Start today: Contact your CF specialist to gather genetic

Getting Elzonris (Tagraxofusp-erzs) Covered by UnitedHealthcare in Washington: Complete PA Guide

Answer Box: Your Fastest Path to Coverage UnitedHealthcare requires prior authorization for Elzonris (tagraxofusp-erzs) and places it on specialty tier. To get approved in Washington: 1) Gather pathology confirming CD123+ BPDCN, recent labs, and clinical notes, 2) Submit PA through the UnitedHealthcare Provider Portal with complete documentation, 3) If denied,

Myths vs. Facts: Getting Mavenclad (Cladribine Tablets) Covered by UnitedHealthcare in Virginia

Answer Box: Getting Mavenclad Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization and step therapy for Mavenclad (cladribine tablets) in Virginia. You must try at least one preferred MS therapy first unless medically contraindicated. Key requirements: confirmed relapsing MS diagnosis, baseline lymphocyte count, negative pregnancy test (if applicable), and

How to Get Elevidys Covered by UnitedHealthcare in New York: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Elevidys Covered by UnitedHealthcare in New York Elevidys (delandistrogene moxeparvovec-rokl) requires prior authorization from UnitedHealthcare in New York. The fastest path: (1) Ensure anti-AAVrh74 antibody titers are <1:400, (2) Document corticosteroid failure/intolerance, (3) Submit through an approved treatment center via the UnitedHealthcare Provider Portal.

How to Get Givlaari (givosiran) Covered by UnitedHealthcare in Texas: Complete Coding and Appeals Guide

Answer Box: To get Givlaari (givosiran) covered by UnitedHealthcare in Texas, you need prior authorization with specific documentation: confirmed acute hepatic porphyria diagnosis (ICD-10 E80.21), elevated ALA/PBG lab results, at least 2 documented attacks in 6 months, and evidence of hemin failure/intolerance. Submit via the UnitedHealthcare Provider

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

Answer Box Oxbryta (voxelotor) is no longer covered by UnitedHealthcare or any insurer because Pfizer voluntarily withdrew it from all markets in September 2024 following FDA safety concerns. All claims for Oxbryta are now universally denied due to loss of FDA approval. If you're currently taking Oxbryta, contact

Work With Your Doctor to Get Imbruvica (ibrutinib) Approved by UnitedHealthcare in Ohio: Provider Collaboration Guide

Answer Box: Getting Imbruvica (ibrutinib) Approved by UnitedHealthcare in Ohio UnitedHealthcare typically requires prior authorization for Imbruvica (ibrutinib) through OptumRx. Success depends on strong provider collaboration: your doctor must document your CLL/SLL/Waldenström diagnosis, prior treatment failures, and clinical rationale aligned with NCCN guidelines. First step today: Schedule a

Complete Requirements Checklist: Get Berinert (C1-Esterase Inhibitor, IV) Covered by UnitedHealthcare in Pennsylvania

Answer Box: Getting Berinert Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Berinert (C1-esterase inhibitor, IV) to treat acute hereditary angioedema attacks. In Pennsylvania, you have strong appeal rights—about 50% of external reviews overturn denials. First step today: Gather your HAE diagnosis documentation (low C4 and C1-INH

Get Keytruda (Pembrolizumab) Covered by UnitedHealthcare in Michigan: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Keytruda Covered by UnitedHealthcare in Michigan Yes, UnitedHealthcare covers Keytruda (pembrolizumab) but requires prior authorization. Your doctor submits the request through the UnitedHealthcare Provider Portal with your diagnosis, biomarker results (like PD-L1 testing), and prior treatment history. If denied, you have 127 days to file an external