Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1139 issues

How to Get Oxervate (Cenegermin) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization & Appeal Guide

Answer Box: Getting Oxervate Covered by UnitedHealthcare in New Jersey Oxervate requires prior authorization from UnitedHealthcare with strict medical necessity criteria. You'll need confirmed Stage 2 or 3 neurotrophic keratitis, documented failure of at least one over-the-counter artificial tear, and prescribing by an ophthalmologist. Submit through the UnitedHealthcare

Getting Cometriq (Cabozantinib) Covered by UnitedHealthcare in New Jersey: Prior Authorization, Appeals, and Step Therapy Protections

Answer Box: Getting Cometriq (Cabozantinib) Covered by UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Cometriq (cabozantinib) capsules for metastatic medullary thyroid carcinoma (MTC) but does not require step therapy for this specific indication. Your fastest path: 1) Confirm MTC diagnosis with your oncologist, 2) Submit PA through UnitedHealthcare

Do You Qualify for Lamzede Coverage by UnitedHealthcare in New York? Complete Decision Tree & Appeals Guide

Answer Box: Quick Coverage Assessment To get Lamzede (velmanase alfa-tycv) covered by UnitedHealthcare in New York: You need confirmed alpha-mannosidosis diagnosis (enzyme deficiency <10% or MAN2B1 mutations), clinical symptoms affecting non-CNS manifestations, and prior authorization through the UnitedHealthcare Provider Portal. If denied, New York's external appeal system

How to Get Crysvita (burosumab) Covered by UnitedHealthcare in Pennsylvania: Complete Guide with Forms, Appeals, and Contacts

Answer Box: Getting Crysvita Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Crysvita (burosumab) in Pennsylvania. Submit through the UnitedHealthcare Provider Portal with required documentation: XLH diagnosis confirmation (genetic testing or elevated FGF23), specialist prescription, and for adults, evidence of failed oral phosphate/calcitriol therapy. If denied, use

How to Get Retevmo (selpercatinib) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Retevmo Covered by UnitedHealthcare in New Jersey Retevmo (selpercatinib) requires prior authorization from UnitedHealthcare OptumRx. Key requirements include FDA-approved RET fusion testing, specific cancer diagnosis documentation, and possible step therapy compliance. If denied, New Jersey's Independent Health Care Appeals Program (IHCAP) provides external review after

How to Get Zolgensma Covered by UnitedHealthcare in New Jersey: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Zolgensma Covered by UnitedHealthcare in New Jersey Eligibility: Pediatric patients under 2 years with bi-allelic SMN1 mutations. Fastest path: Submit prior authorization through OptumRx with genetic confirmation, anti-AAV9 antibody results, and specialist letter. Start today: Contact your pediatric neurologist to initiate baseline testing and gather required documentation.

Work With Your Doctor to Get Humate-P Covered by UnitedHealthcare in Florida: Prior Authorization Guide and Appeal Process

Answer Box: Getting Humate-P Covered by UnitedHealthcare in Florida Humate-P requires prior authorization from UnitedHealthcare for both hemophilia A and von Willebrand disease. For VWD, you must have severe disease OR mild/moderate VWD with documented desmopressin failure. Your doctor submits requests through the UnitedHealthcare Provider Portal or by calling

How to Get Gamifant (Emapalumab) Covered by UnitedHealthcare in Florida: Prior Authorization Guide and Appeal Process

Quick Answer: Getting Gamifant Covered in Florida Gamifant (emapalumab) requires prior authorization from UnitedHealthcare in Florida as of October 2025. The fastest path to approval: 1) Have your hematologist submit clinical documentation proving HLH diagnosis via HLH-2004 criteria, 2) Document failed conventional therapies (etoposide, steroids), and 3) Submit through the

If Pomalyst Isn't Approved by UnitedHealthcare in New Jersey: Formulary Alternatives & Exception Paths

Answer Box: Your Options When Pomalyst Is Denied If UnitedHealthcare denies Pomalyst (pomalidomide) coverage in New Jersey, you have three main paths: try formulary alternatives like Revlimid (lenalidomide), request a formulary exception with strong clinical documentation, or appeal the denial. Start by checking your plan's formulary on the

How to Get Jaypirca (Pirtobrutinib) Covered by UnitedHealthcare in Pennsylvania: Complete Guide to Prior Authorization, Appeals, and Forms

Quick Answer: Getting Jaypirca Covered by UnitedHealthcare in Pennsylvania Jaypirca (pirtobrutinib) requires prior authorization from UnitedHealthcare and is placed on Tier 3 of the OptumRx formulary. To get approved, you'll need documented failure of a prior BTK inhibitor (like ibrutinib) and, for CLL/SLL patients, a BCL-2 inhibitor.