Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1138 issues

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

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

Qalsody (Tofersen) Approval with UnitedHealthcare in Michigan: Answers to the Most Common Questions

Answer Box: Getting Qalsody (Tofersen) Covered by UnitedHealthcare in Michigan Yes, UnitedHealthcare covers Qalsody (tofersen) for ALS patients with confirmed SOD1 mutations, but requires prior authorization through OptumRx. Key requirements: SOD1 genetic testing, neurologist prescription, baseline ALSFRS-R score, and no invasive ventilation. If denied, Michigan residents have 127 days to

Myths vs. Facts: Getting Busulfex (busulfan injection) Covered by UnitedHealthcare in Georgia

Answer Box: Getting Busulfex Covered by UnitedHealthcare in Georgia Busulfex (busulfan injection) requires prior authorization through UnitedHealthcare/OptumRx for bone marrow transplant conditioning. The fastest path to approval: (1) Submit PA via the UnitedHealthcare Provider Portal with complete clinical documentation including diagnosis, prior therapy failures, and transplant protocol details, (2)

Do You Qualify for Galafold (migalastat) Coverage by UnitedHealthcare in New Jersey? Decision Tree & Appeal Guide

Answer Box: Quick Eligibility Check To qualify for Galafold (migalastat) coverage by UnitedHealthcare in New Jersey, you need: (1) confirmed Fabry disease diagnosis, (2) genetic testing showing an "amenable" GLA variant, and (3) no concurrent enzyme replacement therapy. Submit prior authorization through the UnitedHealthcare provider portal with genetic

How to Get Vanflyta (Quizartinib) Covered by UnitedHealthcare in Ohio: Complete Appeal Guide with Forms and Timelines

Quick Answer: Getting Vanflyta Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Vanflyta (quizartinib) through OptumRx. Most approvals need: (1) documented FLT3-ITD positive AML diagnosis, (2) oncologist prescription, (3) baseline EKG showing safe QTc interval, and (4) treatment plan for induction/consolidation phases. If denied, you have 180

If Uptravi (Selexipag) Isn't Approved by UnitedHealthcare in North Carolina: Formulary Alternatives & Exception Paths

Answer Box: When UnitedHealthcare Denies Uptravi (Selexipag) in North Carolina UnitedHealthcare requires step therapy before approving Uptravi (selexipag) for pulmonary arterial hypertension. You'll need to try formulary alternatives first—typically PDE5 inhibitors (sildenafil, tadalafil) or endothelin receptor antagonists (ambrisentan, bosentan)—unless you qualify for an exception. If denied

Get Tecentriq (Atezolizumab) Covered by UnitedHealthcare in North Carolina: Prior Authorization, Appeals & Cost-Saving Strategies

Answer Box: Fastest Path to Tecentriq Coverage Getting Tecentriq (atezolizumab) covered by UnitedHealthcare in North Carolina requires prior authorization with clinical documentation. If denied, you have 180 days for internal appeals, then 120 days for North Carolina's Smart NC external review. Start by having your oncologist submit PA

How to Get Strensiq (Asfotase Alfa) Covered by UnitedHealthcare in North Carolina: Complete Guide to Prior Authorization, Appeals, and State Protections

Answer Box: Getting Strensiq Covered by UnitedHealthcare in North Carolina Eligibility: UnitedHealthcare covers Strensiq (asfotase alfa) for pediatric-onset hypophosphatasia with prior authorization. Requirements: ALPL gene mutation documentation, low alkaline phosphatase levels, and specialist prescription (endocrinologist/geneticist). First step: Submit PA through OptumRx with complete genetic testing results and clinical documentation.

How to Get Rebif (Interferon Beta-1a) Covered by UnitedHealthcare in New York: Timeline, Appeals, and Documentation Guide

Quick Answer: Getting Rebif Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Rebif (interferon beta-1a) in New York, typically taking 1-5 business days for standard requests. Submit through OptumRx's electronic portal with complete documentation: MS diagnosis, MRI results, relapse history, liver function tests, and CBC.