Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1139 issues

If Poteligeo Isn't Approved by UnitedHealthcare in Virginia: Formulary Alternatives & Exception Paths

Answer Box If UnitedHealthcare denies Poteligeo (mogamulizumab-kpkc) for mycosis fungoides or Sézary syndrome in Virginia, you have two paths: try required formulary alternatives first (romidepsin, vorinostat, brentuximab vedotin) or request a step therapy exception with strong clinical documentation. If denied, Virginia's Bureau of Insurance offers external review within
6 min read

UnitedHealthcare's Coverage Criteria for Mepsevii in Florida: What Counts as "Medically Necessary"?

Quick Answer: UnitedHealthcare requires prior authorization for Mepsevii (vestronidase alfa-vjbk) with confirmed MPS VII diagnosis, specialist involvement, and weight-based dosing documentation. Submit PA through OptumRx provider portal with genetic/enzyme testing results. If denied, you have 180 days to file an internal appeal in Florida, followed by external review through
6 min read

Get Elevidys Covered by UnitedHealthcare in Virginia: Complete Guide to Prior Authorization, Appeals, and State External Review

Answer Box: Getting Elevidys Covered by UnitedHealthcare in Virginia Elevidys requires prior authorization from UnitedHealthcare and must be dispensed through designated specialty pharmacies like Accredo or CVS Specialty. First step: Have your neurologist submit a PA request with DMD genetic confirmation, anti-AAVrh74 antibody titer ≤1:400, and detailed medical necessity
5 min read

How to Get Sumavel DosePro Covered by UnitedHealthcare in California: Complete Timeline, Forms & Appeals Guide

Answer Box: Getting Sumavel DosePro Covered by UnitedHealthcare in California Important Note: Sumavel DosePro has been discontinued by the manufacturer, but generic needle-free sumatriptan injections may be available. UnitedHealthcare typically requires prior authorization and step therapy (trying oral triptans first) for injectable sumatriptan products. In California, standard PA decisions take
5 min read

Myths vs. Facts: Getting Ultomiris (Ravulizumab) Covered by UnitedHealthcare in Washington

Answer Box: Getting Ultomiris Covered by UnitedHealthcare in Washington Eligibility: UnitedHealthcare requires prior authorization for Ultomiris (ravulizumab) with step therapy—typically trying eculizumab first. Fastest path: Submit complete PA documentation including diagnosis confirmation (PNH flow cytometry, AChR+ for gMG, AQP4+ for NMOSD), vaccination records, and prior therapy failures. First step
5 min read

Getting Carbaglu (Carglumic Acid) Covered by UnitedHealthcare in Pennsylvania: Prior Authorization Guide and Appeals Process

Quick Answer: To get Carbaglu (carglumic acid) covered by UnitedHealthcare in Pennsylvania, you need prior authorization with genetic/enzyme confirmation of NAGS deficiency, elevated ammonia levels, and specialist documentation. If denied, Pennsylvania's new external review program overturns 50% of appeals. Start by gathering genetic testing results and contacting
5 min read

How to Get Cabometyx (cabozantinib) Covered by UnitedHealthcare in California: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Cabometyx Covered by UnitedHealthcare in California Cabometyx (cabozantinib) requires prior authorization from UnitedHealthcare/OptumRx for all FDA-approved indications. Your fastest path to approval: (1) Ensure your oncologist submits a complete PA request with diagnosis, staging, and prior therapy documentation via the UnitedHealthcare provider portal, (2) If denied,
5 min read