Topic

UnitedHealthcare (UnitedHealth Group)

A collection of 1139 issues

Do You Qualify for Sylvant (Siltuximab) Coverage by UnitedHealthcare in Pennsylvania? Complete Decision Tree & Appeals Guide

Answer Box: Getting Sylvant Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Sylvant (siltuximab) but typically doesn't require step therapy for idiopathic multicentric Castleman disease (iMCD). You qualify if you're 18+, HIV-negative, HHV-8-negative, with confirmed iMCD via lymph node biopsy. Submit through the UnitedHealthcare
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How to Get Therakos CELLEX Photopheresis Covered by UnitedHealthcare in Michigan: Complete Appeal Guide with Forms and Timelines

Quick Answer: Getting Therakos CELLEX Covered by UnitedHealthcare in Michigan Therakos CELLEX photopheresis is covered by UnitedHealthcare for FDA-approved indications (CTCL) and guideline-supported conditions (steroid-refractory GVHD) when medical necessity criteria are met. Prior authorization is required through UnitedHealthcare's medical benefit, not pharmacy. If denied, you have two internal
7 min read

Get Pemazyre (Pemigatinib) Covered by UnitedHealthcare in California: Prior Authorization Guide and Appeal Scripts

Answer Box: Fastest Path to Pemazyre Coverage To get Pemazyre (pemigatinib) covered by UnitedHealthcare in California: You need prior authorization with documented FGFR2 fusion/rearrangement via FDA-approved testing, previous treatment history, and unresectable/metastatic cholangiocarcinoma diagnosis. Submit through UnitedHealthcare provider portal with complete molecular testing results. If denied, file internal
5 min read

Resources to Get Waylivra (Volanesorsen) Approved by UnitedHealthcare in Virginia: Forms, Appeals & Access Options

Answer Box: Getting Waylivra Covered by UnitedHealthcare in Virginia Waylivra (volanesorsen) is not FDA-approved in the United States and is not covered by UnitedHealthcare's standard formularies. However, patients with familial chylomicronemia syndrome (FCS) may pursue coverage through: 1. Medical necessity appeals with comprehensive FCS documentation 2. Expanded access
5 min read

Tracleer (Bosentan) Approval with UnitedHealthcare in Florida: Answers to the Most Common Questions

Answer Box: Quick Path to Tracleer Coverage Tracleer (bosentan) requires prior authorization from UnitedHealthcare in Florida, with strict REMS program compliance. Your prescriber must be a specialist (cardiologist, pulmonologist, or rheumatologist), enroll both you and themselves in the Bosentan REMS program, and submit comprehensive PAH documentation. First step today: Confirm
5 min read

If Oxlumo (Lumasiran) Isn't Approved by UnitedHealthcare in Pennsylvania: Formulary Alternatives & Exception Paths

Answer Box: Your Next Steps When UnitedHealthcare Denies Oxlumo If UnitedHealthcare denied Oxlumo (lumasiran) for primary hyperoxaluria type 1 (PH1) in Pennsylvania, you have three main paths: try formulary alternatives like Rivfloza (nedosiran) or high-dose vitamin B6, request a formulary exception with specialist documentation, or appeal the denial through UnitedHealthcare&
5 min read

How to Get HyperHEP (Hepatitis B Immune Globulin) Covered by UnitedHealthcare in Virginia: Forms, Appeals, and Approval Scripts

Answer Box: Getting HyperHEP Covered by UnitedHealthcare in Virginia UnitedHealthcare requires prior authorization for HyperHEP (hepatitis B immune globulin) in Virginia. Your fastest path to approval: 1) Have your doctor document the specific exposure (needlestick, sexual contact, or perinatal) and timing within 24 hours, 2) Submit PA request through OptumRx
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How to Get Evkeeza (evinacumab-dgnb) Covered by UnitedHealthcare in Florida: Prior Authorization Guide & Appeal Process

Answer Box: Getting Evkeeza Covered by UnitedHealthcare in Florida Evkeeza (evinacumab-dgnb) requires prior authorization from UnitedHealthcare in Florida. To get approved: (1) Confirm your HoFH diagnosis with genetic testing or clinical criteria, (2) Document failure/intolerance of background therapies (statins, ezetimibe, PCSK9 inhibitors), and (3) Submit through the UnitedHealthcare Provider
5 min read

How to Get Daybue (trofinetide) Covered by UnitedHealthcare in North Carolina: Forms, Appeals, and Documentation Guide

Answer Box: Getting Daybue Covered by UnitedHealthcare in North Carolina Daybue (trofinetide) requires prior authorization from UnitedHealthcare for Rett syndrome patients ≥2 years old. The fastest path to approval: (1) Confirm Rett diagnosis with clinical criteria or MECP2 genetic testing, (2) Submit UnitedHealthcare's Daybue-specific PA form through the
6 min read