-
Abilify MyCite (aripiprazole tablet with sensor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 03.22.2019
-
Absorica (isotretinoin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 02.26.2019
-
Absorica (isotretinoin) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Abstral (fentanyl sublingual tablets) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Abstral (fentanyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Actemra (tocilizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Acthar Gel (repository corticotropin injection) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 11.30.2018
-
Acthar Gel (repository corticotropin injection) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.13.2018
-
Actimmune (interferon gamma-1b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
-
Actiq (brand only) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Actiq (fentanyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Adcirca (tadalafil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Adcirca (tadalafil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plan
Last Modified 01.28.2019
-
Adderall (amphetamine-dextroamphetamine mixed salts) and Adderall XR (amphetamine-dextroamphetamine mixed salts, extended release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Addyi (flibanserin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.15.2018
-
Adempas (riociguat) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Adempas (riociguat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Advate (antihemophilic factor [recombinant]) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Adynovate (antihemophilic factor [recombinant], pegylated) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Adzenys XR-ODT (amphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Afinitor (everolimus) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.15.2018
-
Afrezza (insulin, human) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.11.2018
-
Afstyla [Antihemophilic Factor (Recombinant), single chain] - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.15.2018
-
Afstyla [Antihemophilic Factor (Recombinant), single chain] - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.15.2018
-
Aimovig (erenumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Aimovig (erenumab) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.27.2018
-
Ajovy (fremanezumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Ajovy (fremanezumab) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.27.2018
-
Albenza (albendazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
-
Alecensa (alectinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Altreno (tretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.01.2019
-
Alunbrig™ (brigatinib) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
-
Amitiza (lubiprostone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
-
Amitiza (lubiprostone) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.11.2018
-
Amnesteem (isotretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Ampyra (dalfampridine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.10.2018
-
Androderm (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Androgel (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Aptensio XR (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Aptiom (eslicarbazepine acetate) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.11.2018
-
Aptiom (eslicarbazepine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Arcalyst (rilonacept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.15.2018
-
Arikayce - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
-
Arikayce (amikacin liposome inhalation suspension) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 05.01.2019
-
Arymo (morphine sulfate extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.15.2018
-
Atralin (retinoic) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.25.2019
-
Aubagio (teriflunomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Austedo (deutetrabenazine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Austedo (deutetrabenazine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Avinza (morphine sulfate extended-release capsules) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.15.2018
-
Avita (retinoic) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.25.2019
-
Avonex (teriflunomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Axiron (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Banzel (rufinamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.11.2018
-
Belbuca (buprenorphine hydrochloride film) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Belviq - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.27.2018
-
Belviq XR (lorcaserin extended-release) - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Benlysta (belimumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Benznidazole - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Benzphetamine - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.27.2018
-
Berinert (C1 esterase inhibitor, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Betaseron (interferon B-1b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Bethkis (tobramycin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Bonjesta - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Bosulif (bosutinib) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Braftovi (encorafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Bravelle (urofollitropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.21.2018
-
Briviact (brivaracetam) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Briviact Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.11.2018
-
Bunavail/Buprenorphine/Naloxone/Suboxone (buprenorphine/naloxone products) – Prior Authorization/Notification – UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Bupropion SR (generic Zyban) - Prior Authorization - UnitedHealthcare Commercial Plans
Last Modified 03.12.2019
-
Bupropion SR - Tobacco Cessation (Applies to KY Fully Insured) - Supply Limit Override - UnitedHealthcare Commercial Plans
Last Modified 01.08.2019
-
Bupropion SR -Tobacco Cessation (Applies to NJ Fully Insured) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.19.2018
-
Butrans (buprenorphine patch, extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Cabometyx (cabozantinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Calquence (acalabrutinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Caprelsa (vandetanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Carbaglu (carglumic acid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Carospir (spironolactone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Cayston (aztreonam solution for inhalation) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Cerdelga (eliglustat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Cetrotide (cetrorelix acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Chantix (varenicline) - Prior Authorization - UnitedHealthcare Commercial Plans
Last Modified 03.12.2019
-
Chantix / Tobacco Cessation (applies to NJ Fully Insured) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
-
Chantix/Tobacco Cessation (applies to KY Fully Insured) - Supply Limit Override - UnitedHealthcare Commercial Plans
Last Modified 01.08.2019
-
Cholbam (varenicline) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Cimzia (certolizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Cinryze (C1 esterase inhibitor, human) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Cinryze (C1 esterase inhibitor, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Claravis (isotretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Clomid (clomiphene citrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.21.2018
-
Colchicine Tablet (Colcrys authorized generic) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
-
Cometriq (cabozantinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
-
Compounds and Bulk Powders - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Concerta (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Continuous Glucose Monitoring - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 05.05.2019
-
Contrave (naltrexone and bupropion) - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.27.2018
-
Copaxone (glatiramer acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Copiktra - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
-
Corlanor (ivabradine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Cosentyx (secukinumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.15.2019
-
Cotellic (cobimetinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Cotempla XR-ODT (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Crinone (progesterone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Cystaran (cysteamine) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
-
Daklinza (daclatasvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Daklinza (daclatasvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Daliresp (roflumilast) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Daraprim (pyrimethamine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.21.2018
-
Daurismo (glasdegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.22.2019
-
Daytrana (methyphenidate transdermal) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Depakote and Depakote ER (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
-
Depo-Provera (medroxyprogesterone acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Desoxyn (methamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Dexedrine (dextroamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Diabetic Meters and Test Strips - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 05.02.2019
-
Diclegis (doxylamine/pyridoxine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Diethylpropion - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Differin (adapalene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.25.2019
-
Dolophine Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.21.2018
-
Doptelet (avatrombopag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Duopa (carbidopa/levodopa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 11.30.2018
-
Dupixent (dupilumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Dupixent (dupilumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Duragesic Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.21.2018
-
Duzallo (lesinurad/allopurinol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 02.26.2019
-
Dyanavel XR (amphetamine extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Egrifta (tesamorelin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Eligard (leuprolide acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Eloctate (Antihemophilic Factor Recombinant, Fc Fusion Protein) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Eloctate (antihemophilic factor recomninant, Fc fusion protein) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Embeda (morphine sulfate and naltrexone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.20.2018
-
Emflaza (deflazacort) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Emflaza (deflazacort) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Emgality (galcanezumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Emverm (mebendazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
-
Enbrel (etanercept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.21.2018
-
Endari (L-glutamine Powder for Solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Endometrin (progesterone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Entresto (valsartan-sacubitril) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Entresto (valsartan-sacubitril) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.11.2018
-
Epaned (enalapril) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Epclusa (sofosbuvir/velpatasvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Epclusa (sofosbuvir/velpatasvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Epidiolex (cannabidiol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
-
Ergomar (ergotamine) Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.21.2018
-
Erivedge (vismodegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Erleada (apalutamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.12.2019
-
Esbriet (pirfenidone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 11.30.2018
-
Esbriet (pirfenidone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Evekeo (amphetamine sulfate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Evzio (naloxone hydrochloride) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 02.26.2019
-
Exalgo (hydromorphone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.21.2018
-
Exforge - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.21.2018
-
Exjade (deferasirox) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Extavia (interferon β-1b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Fabior (tazarotene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.25.2019
-
Farydak (panobinostat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.21.2018
-
Felbatol (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
-
Fentanyl (opioid analgesics) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Fentanyl citrate powder PA/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Fentanyl Transdermal Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.21.2018
-
Fentora (fentanyl buccal tablet) - Prior Authoriation/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Fentora (fentanyl buccal tablet) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Ferriprox (deferiprone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Firazyr (icatibant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Firdapse® (amifampridine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 05.01.2019
-
FIRST Progesterone VGS (progesterone vaginal suppository compounding kit) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Flolipid (simvastatin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Focalin (dexmethylphenidate) and Focalin XR (dexmethylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Follistim AQ (follitropin beta) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.21.2018
-
Follistim AQ Prior Authorization/Medical Necessity– Supported by Fertility Solutions - UnitedHealthcare Commercial Plans
Last Modified 03.12.2019
-
Fortamet (metformin extended-release, brand and generic) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Forteo (teriparatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Fortesta (topical andogens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Fycompa (perampanel) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Fycompa (perampanel) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.11.2018
-
Galafold™ (migalastat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.27.2018
-
Ganirelix Acetate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Gattex (teduglutide [rDNA origin]) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Genotropin (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.25.2019
-
Genotropin (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Gilenya (fingolimod) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Gilotrif (afatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
-
Glatopa (glatiramer acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Gleevec (imatinib mesylate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.28.2018
-
Glucophage XR (metformin extended-release, brand only) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Glumetza (metformin extended-release, brand and generic) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Gonal f/Gonal f RFF Prior Authorization/Medical Necessity – Supported by Fertility Solutions - UnitedHealthcare Commercial Plans
Last Modified 03.12.2019
-
Gonal-f (follitropin alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.21.2018
-
Gonal-f RFF (follitropin alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.21.2018
-
Grastek (sublingual immunotherapy) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.16.2018
-
Grastek (sublingual Immunotherapy) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.15.2018
-
Haegarda (C1 esterase inhibitor Subcutaneous, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Haegarda - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Harvoni (ledipasvir/sofosbuvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 05.02.2019
-
Harvoni (ledipasvir/sofosbuvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 05.02.2019
-
Health Care Reform Breast Cancer Prevention Copay Reduction Evista - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.12.2019
-
Health Care Reform Breast Cancer Prevention Copay Reduction Soltamax - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.12.2019
-
Health Care Reform Breast Cancer Prevention Copay Reduction Tamoxifen - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.28.2019
-
Hemlibra (emicizumab-kxwh) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.11.2018
-
Hemlibra - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.27.2018
-
Hetlioz (tasimelteon) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Hetlioz (tasimelteon) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Humatrope (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Humatrope (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Humira (adalimumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Hycamtin (topotecan hydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Hysingla ER (hydrocodone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Ibrance (palbociclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Iclusig (ponatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Idhifa (enasidenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Ilumya™ (tildrakizumab-asmn) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 03.15.2019
-
Ilumya™ (tildrakizumab-asmn) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.15.2019
-
Imbruvica (ibrutinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Impavido (miltefosine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Increlex (mecasermin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Increlex (mecasermin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Infertility Medications (applies to Hawaii) - Prior Authorization/Regulatory - UnitedHealthcare Commercial Plans
Last Modified 03.12.2019
-
Ingrezza® (valbenazine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Ingrezza® (valbenazine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Inlyta (axitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Interim New Product Criteria - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Intron-A (interferon alpha-2b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Iressa (gefitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Ixinity (coagulation factor IX recombinant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Jadenu (deferasirox) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Jakafi (ruxolitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Jivi (antihemophilic factor [recombinant], PEGylated-aucl) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 03.15.2019
-
Jivi (antihemophilic factor [recombinant], PEGylated-aucl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.15.2019
-
Jublia (efinaconazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Juxtapid (lomitapide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 05.02.2019
-
Juxtapid (lomitapide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 05.02.2019
-
Jynarque (tolvaptan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Kadian (morphine sulfate sustained-release capsule) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Kalydeco (ivacaftor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Kalydeco (ivacaftor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Keppra and Keppra XR (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
-
Kerydin (tavaborole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Keveyis (dichlorphenamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Kevzara (sarilumab) Injection - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Kineret (anakinra) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Kisqali (ribociclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Kisqali® Femara® Co-Pack (ribociclib/letrozole) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.27.2018
-
Kitabis Pak (tobramycin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Korlym (mifepristone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Kuvan (sapropterin dihydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.11.2018
-
Kynamro (mipomersen sodium) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 11.30.2018
-
Kynamro (mipomersen sodium) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Lamictal and Lamictal XR (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
-
Lamictal ODT (brand and generic) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.19.2018
-
Lazanda (fentanyl nasal spray) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Lazanda (fentanyl nasal spray) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Lenvima (lenvatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Letairis (ambrisentan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 03.12.2019
-
Letairis (ambrisentan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Leuprolide Acetate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Lidocaine Patch (Lidoderm) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.20.2018
-
Linzess (linaclotide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.11.2018
-
Lokelma (sodium zirconium cyclosilicate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 02.26.2019
-
Lonhala Magnair (glycopyrrolate nebulized solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 03.25.2019
-
Lonsurf (trifluridine/tipiracil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Lorbrena (lorlatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 02.26.2019
-
Lotronex (Alosteron) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Lovaza (omega-3-acid ethyl esters) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Lucemyra (lofexidine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
-
Lynparza (olaparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Mavyret (glecaprevir/pibrentasvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Mavyret™ (glecaprevir/pibrentasvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Mekinist (trametinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.20.2018
-
Mektovi (binimetinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Menopur (menotropins) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Menopur Prior Authorization/Medical Necessity - Supported by Fertility Solutions - UnitedHealthcare Commercial Plans
Last Modified 03.12.2019
-
Metadate (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Metadate CD (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Methylin and Methylin ER (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Migranal Nasal Spray (dihydroergotamine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Minocycline extended-release tablet (generic Solodyn), - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 05.01.2019
-
Minolira* (minocycline extended-release tablet) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 05.01.2019
-
Morphabond ER (morphine sulfate extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.20.2018
-
Morphine Sulfate (generic MS Contin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.20.2018
-
Movantik (naloxegol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.27.2018
-
Movantik (naloxegol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.11.2018
-
MS Contin (long-acting opioid analgesic) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Mulpleta® (lusutrombopag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.27.2018
-
Multaq (dronedarone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
-
Myalept (metreleptin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
-
Myalept (metreleptin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.11.2018
-
Mydayis (dextroamphetamine-amphetamine mixed salts) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Myorisan (isotretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Mysoline (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
-
Mytesi (crofelemer) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Natesto (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Natpara (parathyroid hormone analog) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 11.30.2018
-
Natpara (parathyroid hormone analog) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Nerlynx (neratinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Neurontin (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
-
Nexavar (sorafenib tosylate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Nexium (esomeprazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Nicotine Gum / Lozenge / Patch - Prior Authorization - UnitedHealthcare Commercial Plans
Last Modified 03.12.2019
-
Nicotine Gum/Lozenge/Patch - Tobacco Cessation (Applies to KY Fully Insured) - Supply Limit Override - UnitedHealthcare Commercial Plans
Last Modified 01.08.2019
-
Nicotine Gum/Lozenge/Patch - Tobacco Cessation (Applies to NJ Fully Insured) - UnitedHealthcare Commercial Plans
Last Modified 01.08.2019
-
Nicotrol Inhaler (nicotine inhalation system) - Prior Authorization - UnitedHealthcare Commercial Plans
Last Modified 03.12.2019
-
Nicotrol Inhaler - Tobacco Cessation (Applies to KY Fully Insured) - Supply Limit Override - UnitedHealthcare Commercial Plans
Last Modified 01.08.2019
-
Nicotrol Inhaler - Tobacco Cessation (Applies to NJ Fully Insured) - UnitedHealthcare Commercial Plans
Last Modified 03.12.2019
-
Nicotrol NS (nicotine nasal spray) - Prior Authorization - UnitedHealthcare Commercial Plans
Last Modified 03.12.2019
-
Nicotrol NS - Tobacco Cessation (Applies to NJ Fully Insured) - UnitedHealthcare Commercial Plans
Last Modified 03.12.2019
-
Nicotrol NS - Tobacco Cessation (nicotine nasal spray) (Applies to KY Fully Insured) - Supply Limit Override - UnitedHealthcare Commercial Plans
Last Modified 01.08.2019
-
Ninlaro (ixazomib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.20.2018
-
Nityr (nitisinone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Nocdurna (desmopressin acetate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Noctiva (desmopressin acetate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Non-Formulary Copay Adjustment Notification (applies to New Jersey) - Prior Authorization/Regulatory - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
NordiFlex (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
NordiFlex (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Norditropin (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Norditropin (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Northera (droxidopa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.20.2018
-
Novarel (chorionic gonadotropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.20.2018
-
Nucynta ER (tapentadol extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.20.2018
-
Nuedexta (dextromethorphan/quinidine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Nuplazid (pimavanserin tartrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.11.2018
-
Nutropin and Nutropin AQ (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Nutropin AQ (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Nutropin AQ NuSpin (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Nutropin AQ NuSpin (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
NuvaRing (etonogestrel / ethinyl estradiol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Nuvigil (armodafinil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 02.26.2019
-
Ocaliva (obeticholic acid) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
-
Ocaliva (obeticholic acid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
-
Odactra (sublingual immunotherapy) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Odactra (sublingual immunotherapy) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Odomzo (sonidegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Ofev (nintedanib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 11.30.2018
-
Ofev (nintedanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Olumiant - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Olysio (simeprevir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Olysio (simeprevir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Omnitrope (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Omnitrope (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Onfi (clobazam) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
-
Opana ER (oxymorphone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.20.2018
-
Opioid Containing Cough & Cold Medicines - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Opsumit (macitentan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Opsumit (macitentan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Oralair (sublingual immunotherapy) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.17.2018
-
Oralair (sublingual immunotherapy) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.20.2018
-
Orencia (abatacept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Orenitram (treprostinil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Orenitram (treprostinil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Orfadin (nitisinone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.20.2018
-
Orilissa (elagolix) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.27.2018
-
Orkambi (lumacaftor-ivacaftor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Orkambi (lumacaftor-ivacaftor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
OrthoEvra (norelgestromin-ethinyl estradiol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Otezla® (apremilast) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.20.2018
-
Ovidrel (choriogonadotropin alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.20.2018
-
Oxervate (cenegermin-bkbj) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 05.01.2019
-
Oxervate (cenegermin-bkbj) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 05.01.2019
-
Oxistat (oxiconazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 11.30.2018
-
Oxtellar (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
-
OxyContin (oxycodone controlled-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.20.2018
-
Palynziq (pegvaliase-pqpz) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.27.2018
-
Palynziq - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
PEG-Intron (peginterferon alfa-2b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Pegasys (peginterferon alfa-2a) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Phendimetrazine - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.27.2018
-
Phentermine - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.10.2018
-
Plegridy (peginterferon)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Pomalyst (pomalidomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.20.2018
-
Praluent (alirocumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 02.26.2019
-
Praluent (alirocumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Pregnyl (chorionic gonadotropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.20.2018
-
Prevacid SoluTab (lansoprazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Prevymis (letermovir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
-
Procentra (dextroamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Procysbi (cysteamine bitartrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
-
Progesterone bulk powder - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 05.06.2019
-
Promacta (eltrombopag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Provigil (modafanil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 02.26.2019
-
Prudoxin (doxepin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 02.26.2019
-
Pulmozyme (dornase alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Purixan (mercaptopurine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Qbrelis (lisinopril) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Qsymia (phentermine, topiramate extended-release) - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Qudexy XR (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.19.2018
-
QuilliChew ER (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Quillivant XR (methylphenidate extendedrelease) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Ragwitek (sublingual immunotherapy) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.09.2018
-
Ragwitek (sublingual immunotherapy) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.09.2018
-
Ravicti (glycerol phenylbutyrate oral liquid) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.30.2019
-
Ravicti (glycerol phenylbutyrate oral liquid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.30.2019
-
Rebif (interferon β-1a) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Recombinate (antihemophilic factor [recombinant]) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
-
Regranex (becaplermin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
-
Relistor (methylnaltrexone bromide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
-
Repatha (evolocumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 03.15.2019
-
Repatha (evolocumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.10.2018
-
Restasis (cyclosporine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
-
Restasis (cyclosporine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.11.2018
-
Retin-A (tretinoin) / Retin-A Micro (tretinoin microspheres) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.25.2019
-
Revatio (sildenafil citrate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
-
Revatio (sildenafil citrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Revlimid (lenalidomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.10.2018
-
Rexulti (brexpiprazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 02.27.2019
-
Rhofade (oxymetazoline) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
-
Ritalin (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Ritalin LA (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Ritalin SR (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Rubraca (rucaparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Ruconest (C1 esterase inhibitor recombinant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Rydapt™ (midostaurin) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
-
Sabril (vigabatrin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
-
Saizen (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
-
Saizen (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Sandostatin (octreotide acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Saxenda (liraglutide) - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.27.2018
-
Select Excluded Medications - Prior Authorization (Applies to Connecticut, New Jersey, New York) - Commercial
Last Modified 10.17.2018
-
Select Excluded Medications - Prior Authorization (Does NOT apply to Connecticut, New Jersey, New York) - Commercial
Last Modified 10.17.2018
-
Selzentry (maraviroc) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.30.2019
-
Sensipar (cinacalcet) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
-
Serostim (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
-
Serostim (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Signifor (pasireotide diaspartate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
-
Siliq (brodalumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
-
Siliq (brodalumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.15.2019
-
Simponi (golimumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.13.2018
-
Sodium Phenylbutyrate (Buphenyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 02.27.2019
-
Solaraze (diclofenac 3% gel) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Soliqua (insulin glargine/lixisenatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
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Solodyn (generic minocycline extended-release tablet) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
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Somavert (pegvisomant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
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Somavert (pegvisomant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
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Sotylize (sotalol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Sovaldi (sofosbuvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 05.02.2019
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Sovaldi (sofosbuvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.30.2019
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Spritam (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
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Sprycel (dasatinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Sprycel (dasatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
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Stelara (ustekinumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
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Stendra Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.13.2018
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Stivarga (regorafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
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Strensiq (asfotase alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
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Strensiq® (asfotase alfa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.13.2018
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Striant (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.30.2019
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Suboxone Film (buprenorphine HCL-naloxone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.13.2018
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Subsys (fentanyl sublingual spray) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
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Subsys (fentanyl sublingual spray) - Prior Notification/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Sutent (sunitinib malate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.13.2018
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Sylatron (peginterferon alfa-2b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
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Symdeko (texacaftor / ivacaftor) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.30.2019
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Symdeko - (tezacaftor /ivacaftor,) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.30.2019
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Symproic (maldemedine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.11.2018
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Syndros (dronabinol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Synribo (omacetaxine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
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Syprine (trientine hydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
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Tafinlar (dabrafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.13.2018
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Tagrisso (osimertinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
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Takhzyro™ (lanadelumab-flyo) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Taltz (ixekizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 03.15.2019
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Taltz (ixekizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.15.2019
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Talzenna (talazoparib) - Prior Authorization/Notification - UnitedHealthcare Commercial PlansOpens in a new window
Last Modified 02.27.2019
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Tarceva (erlotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
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Tasigna (nilotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
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Tavalisse (fostamatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
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Tazorac (tazarotene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.25.2019
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Tecfidera (dimethyl fumarate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.30.2019
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Technivie (ombitasvir, paritaprevir, ritonavir tablets) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Tegsedi - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Tegsedi™ (inotersen) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Temodar (temozolomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
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Testim (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.30.2019
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Testosterone - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 05.01.2019
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Tetrabenazine (Xenazine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 02.27.2019
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Thalomid (thalidomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.13.2018
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Tibsovo® (ivosidenib) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.27.2018
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Tiglutik (riluzole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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TOBI (tobramycin inhalation solution-powder) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.30.2019
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Topamax (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
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Tracleer (bosentan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Tracleer (bosentan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
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Tremfya (guselkumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
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Tretin-X (tretinoin-cleanser) - Prior Authorization/Notification - UnitedHealthcare
Last Modified 03.25.2019
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Trileptal (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
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Trintellix (vortioxetine) - Prior Authorization - UnitedHealthcare Commercial Plans
Last Modified 08.10.2018
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Trokendi XR (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
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Trulance (plecanatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.11.2018
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Trulance (plecanatide) Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.10.2018
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Tykerb (lapatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
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Tymlos (abaloparatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
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Tyvaso (treprostinil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Tyvaso (treprostinil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
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Ultravate Lotion (halobetasol propionate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.30.2019
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Uptravi (selexipag) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Uptravi (selexipag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
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Valchlor (mechlorethamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
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Vanatol LQ (butalbital, acetaminophen and caffeine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Vascepa (icosapent ethyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
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Vecamyl (mecamylamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.10.2018
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Veltassa (patiromer) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 02.27.2019
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Venclexta (venetoclax) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.10.2018
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Ventavis (iloprost) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Ventavis (iloprost) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
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Vermox (mebendazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
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Verzenio™ (abemaciclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.10.2018
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Viberzi (eluxadoline) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
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Viekira Pak (ombitasvir, paritaprevir, ritonavir, dasabuvir tablets) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 05.06.2019
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Viekira Pak (ombitasvir, paritaprevir, ritonavir, dasabuvir tablets) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 05.06.2019
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Vimpat (lacosamide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Vimpat (lacosamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
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Vitrakvi (larotrectinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.22.2019
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Vizimpro - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Vogelxo (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.30.2019
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Vosevi (sofosbuvir, velpatasvir, and voxilaprevir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Vosevi (sofosbuvir, velpatasvir, and voxilaprevir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
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Votrient (pazopanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
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Vyvanse (lisdexamfetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
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Xadago (safinamide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Xalkori (crizotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 03.25.2019
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Xatmep (methotrexate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Xeljanz / Xeljanz XR (tofacitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
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Xenical (orlistat) - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.27.2018
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Xermelo (telotristat ethyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
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Xifaxan (rifaximin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.10.2018
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Xiidra (lifitegrast 5% ophthalmic solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
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Xiidra (lifitegrast 5% ophthalmic solution) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 12.11.2018
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Ximino (minocycline extended-release capsule) - Prior Authorization/Medical Neccessity - UnitedHealthcare Commercial Plans
Last Modified 04.29.2019
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Xospata (gilteritinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 05.01.2019
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Xtampza ER (oxycodone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.10.2018
-
Xtandi (enzalutamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.31.2018
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Xuriden (uridine triacetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
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Xyntha (antihemophilic factor [recombinant]) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.10.2018
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Xyosted - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 05.02.2019
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Xyrem (sodium oxybate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
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Xyrem (sodium oxybate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
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Yonsa (abiraterone acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 05.01.2019
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Yupelri (revefenacin inhalation solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 03.22.2019
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Zegerid (omeprazole, sodium bicarbonate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Zejula (niraparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.09.2018
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Zelboraf (vemurafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.09.2018
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Zenatane (isotretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 10.01.2018
-
Zenzedi (dextroamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
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Zepatier (elbasvir, grazoprevir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 04.30.2019
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Zepatier (elbasvir, grazoprevir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 04.30.2019
-
Zohydro ER (hydrocodone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 08.09.2018
-
Zomacton (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
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Zomacton (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
-
Zonalon (doxepin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 02.27.2019
-
Zonegran (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 12.12.2018
-
Zorbitive (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 01.29.2019
-
Zorbitive (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 01.28.2019
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Zovirax Ointment (acyclovir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Modified 11.30.2018
-
Zurampic (lesinurad) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 02.27.2019
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Zydelig (idelalisib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 11.29.2018
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Zykadia (ceritinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.31.2018
-
Zytiga (abiraterone acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Modified 08.09.2018
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