Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1133 issues

Getting Rapivab (Peramivir) Covered by UnitedHealthcare in Illinois: Prior Authorization, Appeals & Cost Assistance

Answer Box: Getting Rapivab Covered by UnitedHealthcare in Illinois Rapivab (peramivir) is excluded from UnitedHealthcare's Illinois formulary but can be covered through a formulary exception with strong clinical justification. Your fastest path: 1) Have your doctor submit a prior authorization request with documentation of why oral antivirals (Tamiflu)

Emgality Approval with UnitedHealthcare in Washington: Complete Guide to Prior Authorization, Appeals, and Coverage

Answer Box: Getting Emgality Covered by UnitedHealthcare in Washington UnitedHealthcare covers Emgality (galcanezumab) in Washington with prior authorization. You'll need documentation of migraine diagnosis, at least 4 migraine days per month, and failed trials of 2+ preventive medications. Submit through the UnitedHealthcare Provider Portal with complete clinical records.

How to Get Breyanzi Covered by UnitedHealthcare in New York: Complete Prior Authorization Guide

Answer Box: Getting Breyanzi Covered by UnitedHealthcare in New York Breyanzi (lisocabtagene maraleucel) requires prior authorization from UnitedHealthcare across all plans in New York. Coverage depends on meeting FDA-approved criteria for relapsed/refractory large B-cell lymphoma or chronic lymphocytic leukemia, plus plan-specific step therapy requirements. Your fastest path to approval:

How to Get Kanuma (Sebelipase Alfa) Covered by UnitedHealthcare in California: Complete Guide to Prior Authorization, Appeals, and Cost Assistance

Quick Answer: Getting Kanuma Covered by UnitedHealthcare in California Eligibility: UnitedHealthcare covers Kanuma for confirmed lysosomal acid lipase deficiency (LAL-D) with prior authorization. Fastest path: Submit PA request through UnitedHealthcare provider portal with enzyme/genetic testing and clinical documentation. First step today: Gather LAL enzyme activity test results and contact

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

Answer Box: Getting Opdivo Covered by UnitedHealthcare in Texas Most patients qualify for Opdivo coverage if they have an FDA-approved cancer diagnosis and meet UnitedHealthcare's prior authorization criteria. The fastest path: have your oncologist submit a prior authorization through the UnitedHealthcare Provider Portal with complete staging, biomarker results

How to Get Voydeya (danicopan) Covered by UnitedHealthcare in Michigan: Prior Authorization Forms, Appeals, and Approval Timeline

Quick Answer: Your Path to Voydeya Coverage in Michigan Getting Voydeya (danicopan) covered by UnitedHealthcare in Michigan requires prior authorization with specific documentation: confirmed PNH diagnosis by flow cytometry, evidence of extravascular hemolysis despite C5 inhibitor therapy, completed REMS program enrollment, and current vaccination records (MenACWY and MenB). Submit through

Do You Qualify for Alprolix Coverage by UnitedHealthcare in Pennsylvania? Decision Tree & Next Steps

Answer Box: To qualify for Alprolix coverage by UnitedHealthcare in Pennsylvania, you need confirmed hemophilia B, a hematologist prescription, and documented failure of preferred Factor IX products. Submit prior authorization through the UnitedHealthcare Provider Portal with bleeding history and clinical notes. If denied, Pennsylvania's new external review process

How to Get Tracleer (Bosentan) Covered by UnitedHealthcare in Texas: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Tracleer (Bosentan) Covered by UnitedHealthcare in Texas Tracleer (bosentan) requires prior authorization from UnitedHealthcare in Texas, plus enrollment in the FDA REMS program with monthly liver function testing. Your fastest path: 1) Enroll in REMS and complete baseline labs, 2) Submit PA through the UnitedHealthcare Provider Portal

Do You Qualify for Luxturna Coverage by UnitedHealthcare in Pennsylvania? Complete Decision Tree & Next Steps

Answer Box: Getting Luxturna Covered in Pennsylvania Eligibility: You qualify for Luxturna coverage if you have confirmed biallelic RPE65 mutations, are over 12 months old, have viable retinal cells (>100μm thickness on OCT), and can receive treatment at UPMC Vision Institute or Scheie Eye Institute. Fastest path: Submit UnitedHealthcare

How to Get Rystiggo (rozanolixizumab-noli) Covered by UnitedHealthcare in New Jersey: Complete Authorization Guide

Quick Answer: UnitedHealthcare requires prior authorization for Rystiggo (rozanolixizumab-noli) in New Jersey, with step therapy mandating trials of standard treatments first. Success requires positive AChR or MuSK antibodies, documented treatment failures, and MG-ADL scores showing functional impairment. If denied, New Jersey's Independent Health Care Appeals Program (IHCAP) offers