Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1134 issues

Do You Qualify for Taltz (ixekizumab) Coverage by UnitedHealthcare in Ohio? Decision Tree & Next Steps

Answer Box: Getting Taltz Covered by UnitedHealthcare in Ohio Fastest path to approval: Document moderate-to-severe psoriasis (PASI ≥12 or BSA ≥10%), complete tuberculosis screening, and show failure/intolerance of preferred biologics like adalimumab or etanercept. Submit prior authorization through your dermatologist with comprehensive treatment history. If denied, request peer-to-peer review
5 min read

How to Get Juxtapid (Lomitapide) Covered by UnitedHealthcare in Michigan: Prior Authorization Guide and Appeal Scripts

Answer Box: Getting Juxtapid Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Juxtapid (lomitapide) with strict step therapy requirements. You must first fail or be unable to tolerate both Repatha (evolocumab) and Evkeeza (evinacumab) before approval. Your first step today: Have your cardiologist, endocrinologist, or lipid specialist submit
6 min read

How to Get Chenodal (chenodiol) Approved by UnitedHealthcare in Pennsylvania: Complete PA Guide with Appeals Process

Quick Answer: Getting Chenodal Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Chenodal (chenodiol) with mandatory step therapy through ursodiol first. In Pennsylvania, you have strong appeal rights including a new state-run external review program with a 50% overturn rate. Start today by: 1) Confirming your plan covers
6 min read

How to Get Raxone (Idebenone) Covered by UnitedHealthcare in Illinois: Prior Authorization Forms, Appeals, and Success Strategies

Answer Box: Getting Raxone (Idebenone) Covered by UnitedHealthcare in Illinois Raxone (idebenone) is not FDA-approved in the U.S., making coverage challenging but not impossible. UnitedHealthcare requires prior authorization through OptumRx specialty pharmacy, with robust clinical documentation for Leber Hereditary Optic Neuropathy (LHON). If denied, Illinois residents can appeal internally
6 min read

Do You Qualify for Koselugo Coverage by UnitedHealthcare in North Carolina? Decision Tree & Next Steps

Answer Box: Quick Qualification Check Getting Koselugo (selumetinib) covered by UnitedHealthcare in North Carolina: You'll likely qualify if your child (age 2-18) has confirmed NF1 with symptomatic, inoperable plexiform neurofibromas documented by MRI. First step: Gather baseline LVEF testing, ophthalmologic exam results, and surgical consultation notes confirming inoperability.
6 min read

Renewing Myozyme (Alglucosidase Alfa) Approval with UnitedHealthcare in Pennsylvania: Complete Timeline and Documentation Guide

Answer Box: Renewing Myozyme Coverage with UnitedHealthcare UnitedHealthcare requires prior authorization renewal for Myozyme (alglucosidase alfa) with updated clinical documentation demonstrating continued medical necessity. Start the renewal process 60-90 days before your current authorization expires. Submit updated clinical progress notes, lab results confirming ongoing Pompe disease management, and evidence of
6 min read

UnitedHealthcare's Coverage Criteria for Gilenya (fingolimod) in Illinois: What Counts as "Medically Necessary"?

Answer Box: Getting Gilenya Covered by UnitedHealthcare in Illinois Eligibility: You need a relapsing MS diagnosis, age 10+, neurologist involvement, and typically must try preferred disease-modifying therapies first unless contraindicated. Fastest path: Submit prior authorization through UnitedHealthcare Provider Portal with complete clinical documentation including diagnosis, previous treatments, baseline monitoring results,
6 min read

How to Get Qalsody (Tofersen) Covered by UnitedHealthcare in Florida: Prior Authorization, Appeals, and Provider Partnership Guide

Quick Answer: Getting Qalsody Covered by UnitedHealthcare in Florida Qalsody (tofersen) requires prior authorization through OptumRx for all UnitedHealthcare plans in Florida. Essential requirements include documented SOD1 gene mutation, ALS diagnosis by a neurologist, baseline ALSFRS-R score, and confirmation the patient isn't on invasive ventilation. Submit PA requests
7 min read