Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1138 issues

Work With Your Doctor to Get Elelyso (Taliglucerase Alfa) Approved by UnitedHealthcare in Virginia

Answer Box: Getting Elelyso Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for Elelyso (taliglucerase alfa) with confirmed Type 1 Gaucher disease diagnosis, specialist prescriber, and step therapy documentation. Your fastest path: (1) Confirm you have both enzyme deficiency testing and genetic confirmation, (2) Work with a hematologist or
6 min read

The Requirements Checklist to Get Elfabrio (Pegunigalsidase Alfa-iwxj) Covered by UnitedHealthcare in North Carolina

Answer Box: Getting Elfabrio Covered by UnitedHealthcare in North Carolina Elfabrio (pegunigalsidase alfa-iwxj) requires prior authorization from UnitedHealthcare and is often excluded from standard formularies. The fastest path to approval: (1) Submit complete diagnostic documentation proving confirmed Fabry disease through enzyme deficiency or GLA gene testing, (2) Document step therapy
6 min read

How to Get Gattex (Teduglutide) Covered by UnitedHealthcare in Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Gattex Covered by UnitedHealthcare in Illinois UnitedHealthcare requires prior authorization for Gattex (teduglutide) with strict medical necessity criteria. You must document short bowel syndrome with parenteral nutrition dependence, complete required diagnostics (colonoscopy for adults), and get specialist attestation. First step today: Gather 12 months of PN logs
5 min read

How to Get Cerezyme (Imiglucerase) Approved by UnitedHealthcare in New Jersey: Complete Appeals Guide

Answer Box: Getting Cerezyme Covered by UnitedHealthcare in New Jersey Cerezyme (imiglucerase) requires prior authorization from UnitedHealthcare/OptumRx in New Jersey and may face step therapy requirements. To get coverage: 1. Submit PA request via UnitedHealthcare Provider Portal with Gaucher disease confirmation and specialist documentation 2. Request step therapy exception
6 min read

How Long Does It Take to Get Rezlidhia (olutasidenib) Approved by UnitedHealthcare in Georgia? Complete Timeline & Appeals Guide

Answer Box: Getting Rezlidhia Approved by UnitedHealthcare in Georgia Standard timeline: 7 calendar days for prior authorization decisions through OptumRx. Expedited requests: 2 business days for urgent cases. Your oncologist must document IDH1 mutation status and relapsed/refractory AML diagnosis. If denied, you have 60 days to request external review
6 min read

UnitedHealthcare's Coverage Criteria for Lamzede (velmanase alfa-tycv) in California: What Counts as "Medically Necessary"?

Answer Box: Getting Lamzede Covered by UnitedHealthcare in California UnitedHealthcare requires prior authorization for Lamzede (velmanase alfa-tycv) through OptumRx Specialty Pharmacy. Medical necessity requires confirmed alpha-mannosidosis diagnosis with enzyme deficiency or MAN2B1 gene variants, plus documentation of functional impairment. If denied, California residents can file an Independent Medical Review (IMR)
7 min read

Work With Your Doctor to Get Onivyde (Irinotecan Liposome) Approved by UnitedHealthcare in North Carolina: PA Requirements, Appeals, and Provider Scripts

Quick Answer: Getting Onivyde Approved in North Carolina UnitedHealthcare requires prior authorization for Onivyde (irinotecan liposome) with step therapy requirements. The fastest path: work with your oncologist to submit comprehensive PA documentation showing ECOG 0-1 status, adequate organ function, and either first-line NALIRIFOX eligibility or progression after gemcitabine-based therapy. If
6 min read

Getting Palynziq (pegvaliase-pqpz) Covered by UnitedHealthcare in Georgia: Complete Guide to Prior Authorization, Appeals, and Costs

Quick Answer: Getting Palynziq Covered by UnitedHealthcare in Georgia Yes, UnitedHealthcare covers Palynziq (pegvaliase-pqpz) for adults with PKU in Georgia, but requires strict prior authorization. You must document blood phenylalanine >600 µmol/L, failed sapropterin therapy, and adherence to a restricted diet. If denied, Georgia residents have strong appeal
6 min read

Getting Symdeko/Symkevi Covered by UnitedHealthcare in North Carolina: Complete Prior Authorization Guide

Answer Box: Getting Symdeko/Symkevi Covered by UnitedHealthcare in North Carolina Symdeko (tezacaftor/ivacaftor) requires prior authorization from UnitedHealthcare in North Carolina. Your CF specialist must submit documentation including genetic testing results confirming eligible CFTR mutations (like F508del), diagnosis codes, and clinical notes. Initial approval lasts 6 months with reauthorization
6 min read

How to Get Zanzalintinib (XL092) Covered by UnitedHealthcare in Texas: Appeals, Compassionate Use, and Alternative Pathways

Answer Box: Getting Zanzalintinib (XL092) Covered in Texas Zanzalintinib (XL092) is investigational and typically denied by UnitedHealthcare outside clinical trials. Your fastest path: 1) Submit prior authorization with comprehensive medical necessity documentation through the UnitedHealthcare provider portal, 2) Request peer-to-peer review if denied, 3) File internal appeal within 180 days,
6 min read