Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1136 issues

Getting Pyrukynd (Mitapivat) Covered by UnitedHealthcare in Michigan: Prior Authorization Guide, Appeals Process & Forms

Answer Box: Getting Pyrukynd Covered by UnitedHealthcare in Michigan UnitedHealthcare requires prior authorization for Pyrukynd (mitapivat) in Michigan with strict genetic and clinical criteria. To get approved: (1) Confirm pyruvate kinase deficiency with genetic testing showing at least two PKLR variants (one missense), (2) Have a hematologist or nephrologist submit
6 min read

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

Answer Box: Getting Skyrizi Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Skyrizi (risankizumab) in Virginia with mandatory step therapy—you must try and fail at least one TNF inhibitor first. Submit your PA request through the UHC Provider Portal or call OptumRx at 1-800-711-4555. Include documentation of
6 min read

How to Get Lutathera (Lutetium Lu-177 Dotatate) Covered by UnitedHealthcare in Virginia: Prior Authorization, Appeals & Forms

Quick Answer: Getting Lutathera Covered by UnitedHealthcare in Virginia Lutathera requires prior authorization from UnitedHealthcare OptumRx in Virginia. Your oncologist must submit clinical documentation proving somatostatin receptor positivity, appropriate tumor grading, and progression on octreotide/lanreotide. If denied, you have 180 days for internal appeals, then 120 days to file
5 min read

How to Renew Tysabri (Natalizumab) Coverage with UnitedHealthcare in North Carolina: Evidence Package & Timeline Guide

Answer Box: Renewing Tysabri Coverage with UnitedHealthcare in North Carolina UnitedHealthcare requires annual prior authorization renewal for Tysabri (natalizumab) with specific evidence: recent MRI results, current JCV antibody testing, comprehensive neurologist documentation, and ongoing TOUCH program enrollment. Start renewal 60-90 days before expiration. If denied, North Carolina's Smart
5 min read

Getting Rystiggo (Rozanolixizumab-noli) Covered by UnitedHealthcare in Texas: Coding, Appeals, and Prior Authorization Guide

Answer Box: Fast Track to Rystiggo Coverage UnitedHealthcare requires prior authorization and step therapy for Rystiggo (rozanolixizumab-noli) in Texas. Your fastest path: (1) Gather documentation of AChR/MuSK-positive myasthenia gravis diagnosis with ICD-10 code G70.00 or G70.01, (2) Document failures/intolerances to standard therapies like pyridostigmine and steroids,
6 min read

How to Get Orfadin (nitisinone) Covered by UnitedHealthcare in Ohio: Prior Authorization Guide with Appeals Process

Answer Box: Getting Orfadin Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Orfadin (nitisinone) in Ohio, with automated approval possible within 30 seconds when criteria are met. The fastest path: (1) Confirm HT-1 diagnosis with elevated succinylacetone levels and genetic testing, (2) Submit PA through the UnitedHealthcare Provider
7 min read

How to Get Tavalisse (Fostamatinib) Covered by UnitedHealthcare in Illinois: Complete Guide with Forms and Appeal Strategies

Answer Box: Getting Tavalisse Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Tavalisse (fostamatinib) in Illinois, with strict step therapy requirements including failed corticosteroids and thrombopoietin receptor agonists. Illinois law prohibits step therapy for state-regulated plans as of 2025, but this doesn't apply to self-insured employer
6 min read