-
Abilify MyCite (aripiprazole tablet with sensor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.07.2019
-
Absorica (isotretinoin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Absorica (isotretinoin) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2018
-
Abstral (fentanyl sublingual tablets) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Abstral (fentanyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Actemra (tocilizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Acthar Gel (repository corticotropin injection) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Acthar Gel (repository corticotropin injection) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Actimmune (interferon gamma-1b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Actiq (brand only) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Actiq (fentanyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Adcirca (tadalafil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plan
Last Published 08.27.2019
-
Adcirca® (tadalafil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Adderall (amphetamine-dextroamphetamine mixed salts) and Adderall XR (amphetamine-dextroamphetamine mixed salts, extended release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Addyi (flibanserin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Adempas (riociguat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Adempas® (riociguat) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Adhansia XR (methylphenidate extendedrelease) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Advate (antihemophilic factor [recombinant]) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Adynovate (antihemophilic factor [recombinant], pegylated) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Adzenys XR-ODT (amphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Afinitor (everolimus) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Afrezza (insulin, human) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Afstyla [Antihemophilic Factor (Recombinant), single chain] - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Afstyla [Antihemophilic Factor (Recombinant), single chain] - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Aimovig (erenumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Aimovig (erenumab) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Ajovy (fremanezumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Ajovy (fremanezumab) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Albenza (albendazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Alecensa® (alectinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Altreno (tretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2019
-
Alunbrig™ (brigatinib) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Amitiza (lubiprostone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Amitiza® (lubiprostone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Amnesteem (isotretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2018
-
Ampyra (dalfampridine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Androderm (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Androgel (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Annovera (segesterone/ethinyl estradiol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Aptensio XR (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Aptiom (eslicarbazepine acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Aptiom (eslicarbazepine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Arcalyst (rilonacept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Arikayce (amikacin liposome inhalation suspension) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
-
Arikayce® (amikacin liposome inhalation suspension) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Arymo ER (morphine sulfate extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Atralin (retinoic) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.25.2019
-
Aubagio® (teriflunomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Austedo® (deutetrabenazine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Austedo® (deutetrabenazine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Avinza (morphine sulfate extended-release capsules) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Avita (retinoic) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.25.2019
-
Avonex®(interferon β-1a) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Axiron (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Balversa (erdafitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Banzel (rufinamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Belbuca (buprenorphine hydrochloride film) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Belviq - CA, MD, & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Belviq XR (lorcaserin extended-release) - CA, MD, & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Benlysta® (belimumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Benznidazole - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.23.2019
-
Benzphetamine - CA, MD, & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Berinert (C1 esterase inhibitor, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Betaseron® (interferon β-1b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Bethkis (tobramycin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Bonjesta - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2018
-
Bosulif (bosutinib) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Braftovi™ (encorafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Bravelle (urofollitropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Briviact (brivaracetam) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Briviact Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Bunavail and Suboxone Prior Authorization/Notification – UnitedHealthcare Commercial Plans
Last Published 08.02.2019
-
Butrans (buprenorphine patch, extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Cablivi® (caplacizumab-yhdp) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Cabometyx (cabozantinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Calquence® (acalabrutinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Caprelsa® (vandetanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Carbaglu (carglumic acid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Cardiovascular Disease Prevention - Prior Authorization - UnitedHealthcare Commercial Plans
Last Published 05.29.2019
-
Carospir (spironolactone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Cayston (aztreonam solution for inhalation) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Cequa™ (cyclosporine 0.09% ophthalmic solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.06.2019
-
Cequa™ (cyclosporine 0.09% ophthalmic solution) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.29.2019
-
Cerdelga® (eliglustat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Cetrotide® (cetrorelix acetate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Cetrotide® (cetrorelix acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Chantix (varenicline) – Tobacco Cessation (Applies to KY Fully Insured) – Supply Limit Override - UnitedHealthcare Commercial Plans
Last Published 06.06.2019
-
Chantix (varenicline) – Tobacco Cessation (Applies to NJ Fully Insured) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.06.2019
-
Chantix (varenicline) – Tobacco Cessation - Prior Authorization - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Cholbam™ (cholic acid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Cimzia (certolizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Cinryze (C1 esterase inhibitor, human) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Cinryze (C1 esterase inhibitor, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Claravis (isotretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2018
-
Clomid (clomiphene citrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Colchicine Tablet (Colcrys authorized generic) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Cometriq (cabozantinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Compounds and Bulk Powders - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Concerta (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Continuous Glucose Monitoring - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.22.2019
-
Continuous Glucose Monitors - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Contrave (naltrexone and bupropion) - CA, MD, & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Copaxone®(glatiramer acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Copiktra® (duvelisib)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Corlanor® (ivabradine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Cosentyx (secukinumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.15.2019
-
Cotellic® (cobimetinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Cotempla XR-ODT (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Crinone (progesterone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Cystaran (cysteamine) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Daklinza (daclatasvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Daklinza® (daclatasvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Daliresp® (roflumilast) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Daraprim (pyrimethamine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Daurismo (glasdegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.22.2019
-
Daytrana (methyphenidate transdermal) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Depakote and Depakote ER (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Depo-Provera® (medroxyprogesterone acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Desoxyn (methamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Devices - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Dexedrine (dextroamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Diabetic Meters and Test Strips - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.02.2019
-
Diacomit (stiripentol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Diclegis (doxylamine/pyridoxine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Diethylpropion - CA, MD, & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Differin (adapalene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.25.2019
-
Dolophine (methadone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Doptelet (avatrombopag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Duopa (carbidopa/levodopa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Dupixent (dupilumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Dupixent®(dupilumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Duragesic (fentanyl transdermal) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Duzallo (lesinurad/allopurinol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.26.2019
-
Dyanavel XR (amphetamine extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Egrifta (tesamorelin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Eligard® (leuprolide acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Eloctate (Antihemophilic Factor Recombinant, Fc Fusion Protein) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Eloctate® (antihemophilic factor recomninant, Fc fusion protein) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Emflaza® (deflazacort) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Emflaza® (deflazacort) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Emgality (galcanezumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Emgality (galcanezumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Emverm (mebendazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Enbrel (etanercept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.22.2019
-
Endari (L-glutamine Powder for Solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Endometrin (progesterone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Entresto (valsartan-sacubitril) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Entresto (valsartan-sacubitril) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Epaned (enalapril) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Epclusa (sofosbuvir/velpatasvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Epclusa (sofosbuvir/velpatasvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Epidiolex (cannabidiol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Epidiolex (cannabidiol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Ergomar (ergotamine) Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Erivedge® (vismodegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Erleada ® (apalutamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Esbriet® (pirfenidone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Esbriet® (pirfenidone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Evekeo (amphetamine sulfate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.06.2020
-
Evekeo ODT (amphetamine sulfate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Evzio (naloxone hydrochloride) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2019
-
Exalgo (hydromorphone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Exforge - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Exjade® (deferasirox) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Extavia® (interferon β-1b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Fabior (tazarotene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.25.2019
-
Farydak (panobinostat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.06.2019
-
Fasenra™ (benralizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Fasenra™ (benralizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Felbatol (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Fentanyl citrate powder - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Fentanyl Transdermal - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Fentora (fentanyl buccal tablet) - Prior Authorization / Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.14.2020
-
Fentora (fentanyl buccal tablet) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Ferriprox® (deferiprone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Firazyr (icatibant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Firdapse® (amifampridine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Firdapse® (amifampridine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
-
FIRST Progesterone VGS (progesterone vaginal suppository compounding kit) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Flolipid (simvastatin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.09.2020
-
Focalin (dexmethylphenidate) and Focalin XR (dexmethylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Follistim AQ (follitropin beta) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Follistim® AQ (follitropin beta) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Fortamet (metformin extended-release, brand and generic) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Forteo™ (teriparatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Fortesta (topical andogens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Fycompa (perampanel) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Fycompa (perampanel) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Galafold™ (migalastat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Ganirelix Acetate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Gattex® (teduglutide [rDNA origin]) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Genotropin® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Genotropin® (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Gilenya®(fingolimod) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Gilotrif (afatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Glatopa™ (glatiramer acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Gleevec® (imatinib mesylate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Glucophage XR (metformin extended-release, brand only) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Glumetza (metformin extended-release, brand and generic) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Gonal-f (follitropin alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Gonal-f RFF (follitropin alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Gonal-f™ (follitropin alfa)/Gonal-f™ RFF (follitropin alfa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Gonococcal Ophthalmia Neonatorum Prevention - Prior Authorization/Regulatory - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Grastek (sublingual immunotherapy) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Grastek (sublingual Immunotherapy) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Haegarda (C1 esterase inhibitor Subcutaneous, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Haegarda - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Harvoni (ledipasvir/sofosbuvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Harvoni (ledipasvir/sofosbuvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.02.2019
-
Health Care Reform Breast Cancer Prevention Copay Reduction Tamoxifen - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Health Care Reform Breast Cancer Prevention Copay Reduction-generic Aromatase Inhibitors (NY Only) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Hemlibra® (emicizumab-kxwh) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Hemlibra® (emicizumab-kxwh)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Hetlioz (tasimelteon) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Hetlioz (tasimelteon) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
HIV Pre-Exposure Prophylaxis Zero Dollar Cost Share - tenofovir - for NY- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Humatrope® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Humatrope® (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Humira (adalimumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Hycamtin® (topotecan hydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Hysingla ER (hydrocodone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Ibrance (palbociclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Ibsrela (tenapanor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Ibsrela (tenapanor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Iclusig® (ponatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Idhifa® (enasidenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Ilumya™ (tildrakizumab-asmn) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Ilumya™ (tildrakizumab-asmn) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.15.2019
-
Imbruvica® (ibrutinib)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.19.2020
-
Impavido (miltefosine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.24.2019
-
Inbrija (levodopa inhalation powder) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Inbrija (levodopa inhalation powder) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Increlex (mecasermin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Increlex (mecasermin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Infertility Medications (applies to Hawaii) - Prior Authorization/Regulatory - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Ingrezza® (valbenazine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Ingrezza® (valbenazine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Inlyta® (axitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Inrebic® (fedratinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Interim New Product Criteria - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Intron-A (interferon alpha-2b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Iressa® (gefitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Ixinity (coagulation factor IX recombinant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Jadenu® (deferasirox) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Jakafi (ruxolitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.23.2019
-
Jatenzo (testosterone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Jivi (antihemophilic factor [recombinant], PEGylated-aucl) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.15.2019
-
Jivi (antihemophilic factor [recombinant], PEGylated-aucl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.15.2019
-
Jornay PM (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Jublia (efinaconazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Juxtapid (lomitapide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.02.2019
-
Juxtapid® (lomitapide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Jynarque (tolvaptan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Kadian (morphine sulfate sustained-release capsule) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Kalydeco (ivacaftor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Kalydeco (ivacaftor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Katerzia (amlodipine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Keppra and Keppra XR (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.09.2020
-
Kerydin (tavaborole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Keveyis (dichlorphenamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Kevzara (sarilumab) Injection - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Kineret (anakinra) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.23.2019
-
Kisqali® (ribociclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Kisqali® Femara® Co-Pack (ribociclib/letrozole) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Kitabis Pak (tobramycin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Korlym (mifepristone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.23.2019
-
Kuvan (sapropterin dihydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Kynamro (mipomersen sodium) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2018
-
Lamictal and Lamictal XR (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Lamictal ODT (brand and generic) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Lazanda (fentanyl nasal spray) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Lazanda (fentanyl nasal spray) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Lenvima™ (lenvatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Letairis (ambrisentan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Letairis® (ambrisentan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Leuprolide Acetate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Lidocaine Patch (Lidoderm) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.24.2019
-
Linzess®- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Lokelma (sodium zirconium cyclosilicate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2019
-
Lonhala Magnair (glycopyrrolate nebulized solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Lonsurf (trifluridine/tipiracil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Lorbrena (lorlatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Lotronex* (alosetron)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Lovaza® (omega-3-acid ethyl esters) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Lucemyra (lofexidine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Lynparza™ (olaparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.06.2019
-
Lyrica - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Mavenclad® (cladribine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Mavyret™ (glecaprevir/pibrentasvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Mavyret™ (glecaprevir/pibrentasvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Mayzent® (siponimod) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Mekinist (trametinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.23.2019
-
Mektovi™ (binimetinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Menopur (menotropins) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Menopur® (menotropins) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Metadate (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.06.2020
-
Metadate CD (methylphenidate extended release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Methylin and Methylin ER (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Migranal Nasal Spray (dihydroergotamine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Minocycline extended-release tablet (generic Solodyn), - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
-
Minolira* (minocycline extended-release tablet) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
-
Morphabond ER (morphine sulfate extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Morphine Sulfate (generic MS Contin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Motegrity (prucalopride) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Motegrity (prucalopride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Movantik (naloxegol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Movantik (naloxegol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
MS Contin (long-acting opioid analgesic) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Mulpleta® (lusutrombopag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Multaq (dronedarone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Myalept (metreleptin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Myalept (metreleptin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Mydayis (dextroamphetamine-amphetamine mixed salts) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Myorisan (isotretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2018
-
Mysoline (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Mytesi (crofelemer) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Naprosyn (naproxen) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Natesto (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Natpara® (parathyroid hormone analog) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Natpara® (parathyroid hormone analog) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Nerlynx® (neratinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Neurontin (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
New & Therapeutic Equivalent Medications - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
New & Therapeutic Equivalent Medications Excluded Drug - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Nexavar® (sorafenib tosylate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Nexium (esomeprazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Nicotine Gum / Lozenge / Patch - Prior Authorization - UnitedHealthcare Commercial Plans
Last Published 03.12.2019
-
Nicotine Gum/Lozenge/Patch - Tobacco Cessation (Applies to KY Fully Insured) - Supply Limit Override - UnitedHealthcare Commercial Plans
Last Published 01.08.2019
-
Nicotine Gum/Lozenge/Patch - Tobacco Cessation (Applies to NJ Fully Insured) - UnitedHealthcare Commercial Plans
Last Published 01.08.2019
-
Nicotrol Inhaler (nicotine inhalation system) - Tobacco Cessation (Applies to KY Fully Insured) - Supply Limit Override - UnitedHealthcare Commercial Plans
Last Published 06.06.2019
-
Nicotrol Inhaler (nicotine inhalation system) - Tobacco Cessation (Applies to NJ Fully Insured) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.06.2019
-
Nicotrol Inhaler (nicotine inhalation system) – Tobacco Cessation - Prior Authorization - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Nicotrol NS (nicotine nasal spray) – Tobacco Cessation (Applies to KY Fully Insured) – Supply Limit Override - UnitedHealthcare Commercial Plans
Last Published 06.06.2019
-
Nicotrol NS (nicotine nasal spray) – Tobacco Cessation (Applies to NJ Fully Insured) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.06.2019
-
Nicotrol NS (nicotine nasal spray) – Tobacco Cessation - Prior Authorization - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Ninlaro® (ixazomib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.06.2019
-
Nityr™ (nitisinone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Nocdurna (desmopressin acetate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Noctiva (desmopressin acetate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Non-Formulary Copay Adjustment Notification (applies to New Jersey) - Prior Authorization/Regulatory - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
NordiFlex® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
NordiFlex® (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Norditropin (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Norditropin® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Northera (droxidopa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Nourianz (istradefylline) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Novarel® (chorionic gonadotropin)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Nubeqa® (darolutamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Nucala® (mepolizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Nucala® (mepolizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Nucynta ER (tapentadol extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Nuedexta (dextromethorphan/quinidine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Nuplazid (pimavanserin tartrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Nutropin AQ® NuSpin™ (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Nutropin AQ® NuSpin™ (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Nutropin®, Nutropin AQ® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Nutropin®, Nutropin AQ® (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
NuvaRing® (etonogestrel / ethinyl estradiol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Nuvigil (armodafinil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.26.2019
-
Ocaliva (obeticholic acid) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Ocaliva (obeticholic acid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Odactra (sublingual immunotherapy) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.06.2019
-
Odactra (sublingual immunotherapy) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.24.2019
-
Odomzo® (sonidegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Ofev® (nintedanib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Ofev® (nintedanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Olumiant - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Olysio (simeprevir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2018
-
Omnitrope® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Omnitrope®(somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Onfi (clobazam) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Onfi - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Opana ER (oxymorphone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Opioid Containing Cough & Cold Medicines PA/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Opsumit (macitentan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Opsumit® (macitentan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Oral Oncology Agents - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Oralair (sublingual immunotherapy) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.06.2019
-
Oralair (sublingual immunotherapy) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.24.2019
-
Orencia (abatacept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Orenitram (treprostinil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Orenitram™ (treprostinil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Orfadin (nitisinone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Orilissa (elagolix) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Orkambi™ (lumacaftor/ivacaftor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Orkambi™ (lumacaftor/ivacaftor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
OrthoEvra® (norelgestromin-ethinyl estradiol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Osphena (ospemifene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.07.2019
-
Otezla® (apremilast) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.06.2019
-
Ovidrel® (choriogonadotropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Oxervate (cenegermin-bkbj) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
-
Oxervate (cenegermin-bkbj) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
-
Oxistat (oxiconazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Oxtellar (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
OxyContin (oxycodone controlled-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Palynziq (pegvaliase-pqpz) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Palynziq - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
PEG-Intron® (peginterferon alfa-2b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Pegasys® (peginterferon alfa-2a) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Phendimetrazine - CA, MD, & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.05.2019
-
Phentermine - CA, MD, & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.05.2019
-
Piqray® (alpelisib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Plegridy™ (peginterferon)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Pomalyst (pomalidomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Praluent (alirocumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Praluent™ (alirocumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Pregnyl® (chorionic gonadotropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Prevacid SoluTab (lansoprazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Prevymis (letermovir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Procentra (dextroamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Procysbi (cysteamine bitartrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Progesterone bulk powder - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.06.2019
-
Promacta® (eltrombopag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Provigil (modafanil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.26.2019
-
Prudoxin (doxepin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.26.2019
-
Pulmozyme (dornase alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Purixan (mercaptopurine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Qbrelis (lisinopril) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Qsymia (phentermine, topiramate extended-release) - CA, MD, & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.05.2019
-
Qudexy XR (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
QuilliChew ER (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Quillivant XR (methylphenidate extendedrelease) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Ragwitek (sublingual immunotherapy) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Ragwitek (sublingual immunotherapy) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Ravicti (glycerol phenylbutyrate oral liquid) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
-
Ravicti (glycerol phenylbutyrate oral liquid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
-
Rebif® (interferon β-1a) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Recombinate (antihemophilic factor [recombinant]) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Regranex (becaplermin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Relistor (methylnaltrexone bromide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Repatha (evolocumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Repatha™ (evolocumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Restasis (cyclosporine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Restasis (cyclosporine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.24.2019
-
Retin-A (tretinoin) / Retin-A Micro (tretinoin microspheres) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.25.2019
-
Revatio (sildenafil citrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Revatio® (sildenafil citrate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Revlimid (lenalidomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Rexulti (brexpiprazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Rhofade (oxymetazoline) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Rinvoq™ (upadacitinib) extended-release tablets - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Ritalin (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Ritalin LA (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Ritalin SR (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Rozlytrek™ (entrectinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Rubraca® (rucaparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Ruconest (C1 esterase inhibitor recombinant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Ruzurgi® (amifampridine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Rydapt™ (midostaurin) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Sabril (vigabatrin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Saizen® (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.09.2020
-
Saizen®(somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Samsca (tolvaptan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Sandostatin® (octreotide acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Saxenda (liraglutide) - CA, MD, & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.05.2019
-
Selzentry (maraviroc) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
-
Sensipar (cinacalcet) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Serostim® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Serostim® (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Signifor® (pasireotide diaspartate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Siliq (brodalumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Siliq (brodalumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.15.2019
-
Simponi (golimumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Skyrizi™ (risankizumab-rzaa) injection - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Sodium Phenylbutyrate (Buphenyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Solaraze (diclofenac 3% gel) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Soliqua (insulin glargine/lixisenatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Solodyn (generic minocycline extended-release tablet) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Somavert (pegvisomant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Somavert (pegvisomant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Sotylize (sotalol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Sovaldi (sofosbuvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.02.2019
-
Sovaldi (sofosbuvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
-
Spravato™ (esketamine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Spravato™ (esketamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.07.2019
-
Spritam (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Sprycel® (dasatinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Sprycel® (dasatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Stelara™ (ustekinumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Stendra (avanafil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2019
-
Stivarga (regorafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Strensiq® (asfotase alfa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Strensiq™ (asfotase alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Striant (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Suboxone Film (buprenorphine HCL-naloxone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.13.2018
-
Subsys (fentanyl sublingual spray) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Subsys (fentanyl sublingual spray) - Prior Notification/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Sucraid (sacrosidase) oral solution - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Sucraid (sacrosidase) oral solution - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Sunosi™ (solriamfetol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Sunosi™ (solriamfetol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Sutent (sunitinib malate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.24.2019
-
Sylatron™ (peginterferon alfa-2b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Symdeko (texacaftor / ivacaftor) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Symdeko - (tezacaftor /ivacaftor,) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Sympazan (clobazam) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Symproic (maldemedine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Syndros (dronabinol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Synribo® (omacetaxine)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Syprine (trientine hydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Tafinlar (dabrafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.24.2019
-
Tagrisso™ (osimertinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Takhzyro™ (lanadelumab-flyo) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Takhzyro™ (lanadelumab-flyo) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Taltz (ixekizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Taltz™ (ixekizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Talzenna™ (talazoparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Tarceva® (erlotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Tasigna® (nilotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Tavalisse (fostamatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Tazorac (tazarotene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.25.2019
-
Tecfidera™ (dimethyl fumarate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Technivie (ombitasvir, paritaprevir, ritonavir tablets) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
-
Tegsedi - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
-
Tegsedi™ (inotersen) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Temodar® (temozolomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Testim (topical androgens) -i Pror Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Testosterone - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
-
Tetrabenazine (Xenazine®) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Thalomid (thalidomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Tibsovo® (ivosidenib) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Tiglutik (riluzole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Tirosint-Sol (levothyroxine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
TOBI (tobramycin inhalation solution-powder) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
-
Topamax (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Tracleer (bosentan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Tracleer® (bosentan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Tremfya (guselkumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Tretin-X (tretinoin-cleanser) - Prior Authorization/Notification - UnitedHealthcare
Last Published 03.25.2019
-
Trikafta - Prior Authorization/Medical Necessity Medication - UnitedHealthcare Commercial Plans
Last Published 11.25.2019
-
Trikafta - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.25.2019
-
Trileptal (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Trintellix (vortioxetine) - Prior Authorization - UnitedHealthcare Commercial Plans
Last Published 08.10.2018
-
Trokendi XR (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Trulance (plecanatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Trulance (plecanatide) Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Turalio™ (pexidartinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Tykerb® (lapatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Tymlos™ (abaloparatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Tyvaso (treprostinil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Tyvaso® (treprostinil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Ultravate Lotion (halobetasol propionate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
-
Uptravi (selexipag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Uptravi® (selexipag) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Valchlor® (mechlorethamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Vanatol LQ (butalbital, acetaminophen and caffeine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Vascepa® (icosapent ethyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Vecamyl (mecamylamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Veltassa (patiromer) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.27.2019
-
Venclexta (venetoclax) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Ventavis (iloprost) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Ventavis® (iloprost) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Vermox (mebendazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Verzenio™ (abemaciclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Viberzi (eluxadoline) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.06.2019
-
Viekira Pak (ombitasvir, paritaprevir, ritonavir, dasabuvir tablets) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.06.2019
-
Viekira Pak (ombitasvir, paritaprevir, ritonavir, dasabuvir tablets) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.06.2019
-
Vimpat (lacosamide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Vimpat (lacosamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Vitrakvi (larotrectinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.22.2019
-
Vizimpro® (dacomitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Vogelxo (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Vosevi™ (sofosbuvir, velpatasvir, and voxilaprevir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Vosevi™ (sofosbuvir, velpatasvir, and voxilaprevir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Votrient™ (pazopanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Vyleesi (bremelanotide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Vyndamax (tafamidis) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Vyndamax (tafamidis) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Vyndaqel® (tafamidis meglumine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Vyndaqel® (tafamidis meglumine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Vyvanse (lisdexamfetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Wakix® (pitolisant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Wakix® (pitolisant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Xalkori (crizotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.25.2019
-
Xatmep (methotrexate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Xeljanz / Xeljanz XR (tofacitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Xenical (orlistat) - CA, MD, & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.05.2019
-
Xermelo (telotristat ethyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Xifaxan (rifaximin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Xiidra (lifitegrast 5% ophthalmic solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Xiidra (lifitegrast 5% ophthalmic solution) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.24.2019
-
Ximino (minocycline extended-release capsule) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.14.2020
-
Xospata (gilteritinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
-
Xpovio™ (selinexor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Xtampza ER (oxycodone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Xtandi® (enzalutamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Xuriden (uridine triacetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Xyntha (antihemophilic factor [recombinant]) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Xyosted - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Xyrem (sodium oxybate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Xyrem® (sodium oxybate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Yonsa (abiraterone acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
-
Yupelri (revefenacin inhalation solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Zegerid (omeprazole, sodium bicarbonate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Zejula (niraparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Zelboraf (vemurafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.24.2019
-
Zelnorm (tegaserod) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Zelnorm (tegaserod) - Prior Authorization/Notification - UnitedHealthcare Commercial
Last Published 02.25.2020
-
Zenatane (isotretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2018
-
Zenzedi (dextroamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Zepatier (elbasvir, grazoprevir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
-
Zepatier (elbasvir, grazoprevir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
-
Zohydro ER (hydrocodone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Zomacton® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Zomacton® (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Zonalon (doxepin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.27.2019
-
Zonegran (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Zorbitive (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Zorbtive® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Zovirax Ointment (acyclovir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Zurampic (lesinurad) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.27.2019
-
Zydelig® (idelalisib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Zykadia (ceritinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Zytiga (abiraterone acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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- Clinical Pharmacy Prior Authorization, Notification and Medical Necessity Requirements - Commercial
Mar 26, 2020
Click here for a message from Anne Boland Docimo, M.D., UnitedHealthcare’s chief medical officer, with updates on our prior authorization requirements, telehealth policies and more.
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