Clinical Pharmacy Prior Authorization, Notification and Medical Necessity Requirements - Commercial
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Abilify MyCite (aripiprazole tablet with sensor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Absorica (isotretinoin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
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Abstral (fentanyl sublingual tablets) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Abstral (fentanyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Actemra (tocilizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Actemra® (tocilizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Acthar Gel (repository corticotropin injection) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
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Acthar Gel®(repository corticotropin injection) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Actimmune® (interferon gamma-1b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Actiq (brand only) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Actiq (fentanyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Adcirca® (tadalafil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Adcirca® (tadalafil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plan
Last Published 08.17.2020
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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
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Addyi (flibanserin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
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Adempas® (riociguat) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Adempas® (riociguat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Adhansia XR (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.14.2020
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Advate (antihemophilic factor [recombinant]) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Adynovate (antihemophilic factor [recombinant], pegylated) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Adzenys XR-ODT (amphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
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Afinitor (everolimus) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
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Afrezza (insulin, human) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Afstyla (antihemophilic factor [recombinant], single chain) - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
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Afstyla [Antihemophilic Factor (Recombinant), single chain] - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
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Aimovig (erenumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Aimovig (erenumab) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Ajovy (fremanezumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Ajovy (fremanezumab) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Aklief® (trifarotene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Albenza (albendazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Alecensa® (alectinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
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Altreno® (tretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Alunbrig™ (brigatinib) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Amitiza (lubiprostone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Amitiza (lubiprostone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Amitiza® (lubiprostone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
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Ampyra® (dalfampridine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
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Amzeeq (minocycline 4% topical foam) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Androgel (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Annovera (segesterone/ethinyl estradiol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Aptensio XR (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
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Aptiom (eslicarbazepine acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Aptiom (eslicarbazepine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Arcalyst®(rilonacept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Arikayce® (amikacin liposome inhalation suspension) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
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Arikayce® (amikacin liposome inhalation suspension) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Arymo ER (morphine sulfate extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Atralin™ (retinoic) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Aubagio® (teriflunomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
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Austedo® (deutetrabenazine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Austedo® (deutetrabenazine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Avinza (morphine sulfate extended-release capsules) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Avita® (retinoic) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Avonex® (interferon β-1a) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
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Axiron (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Ayvakit (avapritinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
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Ayvakit (avapritinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
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Balversa® (erdafitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
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Banzel (rufinamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Belbuca (buprenorphine hydrochloride film) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Belviq - CA, MD, & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
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Belviq XR (lorcaserin extended-release) - CA, MD, & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
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Benlysta® (belimumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
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Benznidazole - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
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Benzphetamine - CA, MD, & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
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Berinert® (C1 esterase inhibitor [human]) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Berinert® (C1 esterase inhibitor, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Betaseron® (interferon β-1b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
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Bethkis®(tobramycin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
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Bonjesta - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2018
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Bosulif® (bosutinib) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
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Braftovi™ (encorafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Briviact (brivaracetam) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Briviact Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Brukinsa™ (zanubrutinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
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Bunavail and Suboxone Prior Authorization/Notification – UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Butrans (buprenorphine patch, extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Cablivi® (caplacizumab-yhdp) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Cabometyx (cabozantinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
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Calquence® (acalabrutinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Caplyta (lumateperone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Caplyta (lumateperone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Caprelsa® (vandetanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
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Carbaglu™ (carglumic acid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Cardiovascular Disease Prevention - Prior Authorization - UnitedHealthcare Commercial Plans
Last Published 06.29.2020
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Carospir (spironolactone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
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Cayston®(aztreonam solution for inhalation) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
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Cequa™ (cyclosporine 0.09% ophthalmic solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Cequa™ (cyclosporine 0.09% ophthalmic solution) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.02.2020
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Cerdelga® (eliglustat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
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Cetrotide® (cetrorelix acetate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
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Cetrotide® (cetrorelix acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
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Chantix (varenicline) – Tobacco Cessation (Applies to KY Fully Insured) – Supply Limit Override - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
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Chantix (varenicline) – Tobacco Cessation (Applies to NJ Fully Insured) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
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Chantix (varenicline) – Tobacco Cessation - Prior Authorization - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
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Cholbam™ (cholic acid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
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Cimzia (certolizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
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Cimzia® (certolizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Cinryze® (C1 esterase inhibitor, human) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Cinryze® (C1 esterase inhibitor, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Clomid (clomiphene citrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
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Colchicine tablet (Colcrys authorized generic) - Prior Authorization/Excluded Drug - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
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Cometriq® (cabozantinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Compounds and Bulk Powders - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
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Concerta (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
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Continuous Glucose Monitoring - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
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Continuous Glucose Monitors - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
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Contrave (naltrexone and bupropion) - CA, MD, & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
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Copaxone® (glatiramer acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
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Copiktra® (duvelisib)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Corlanor® (ivabradine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Cosentyx™ (secukinumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Cosentyx™ (secukinumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Cotellic® (cobimetinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Cotempla XR-ODT (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
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Crinone® (progesterone gel) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
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Cystaran®(cysteamine) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Daklinza® (daclatasvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
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Daliresp® (roflumilast) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Daraprim® (pyrimethamine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
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Daurismo™ (glasdegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
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Daytrana (methyphenidate transdermal) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
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Depakote and Depakote ER (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Depo-Provera® (medroxyprogesterone acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Descovy® (emtricitabine/tenofovir alafenamide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.31.2020
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Desoxyn (methamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
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Devices - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Dexedrine (dextroamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
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Diabetic Meters and Test Strips - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Diacomit (stiripentol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Diclegis (doxylamine/pyridoxine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
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Diethylpropion - CA, MD, & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
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Differin® (adapalene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Dolophine (methadone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Doptelet (avatrombopag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
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Drizalma Sprinkle (duloxetine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
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Duopa (carbidopa/levodopa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
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Dupixent® (dupilumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Dupixent® (dupilumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Duragesic (fentanyl transdermal) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Duzallo (lesinurad/allopurinol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.26.2019
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Dyanavel XR (amphetamine extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
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Egrifta® (tesamorelin for injection) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
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Eligard® (leuprolide acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
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Eloctate (Antihemophilic Factor Recombinant, Fc Fusion Protein) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Eloctate® (antihemophilic factor recomninant, Fc fusion protein) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Emflaza® (deflazacort) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Emflaza® (deflazacort) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Emgality (galcanezumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Emgality (galcanezumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Emverm (mebendazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Enbrel (etanercept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
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Enbrel® (etanercept) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Endari (L-glutamine Powder for Solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
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Endometrin® (progesterone vaginal insert) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
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Entresto (valsartan-sacubitril) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Entresto (valsartan-sacubitril) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Epaned (enalapril) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
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Epclusa (sofosbuvir/velpatasvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Epclusa (sofosbuvir/velpatasvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
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Epidiolex (cannabidiol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Epidiolex (cannabidiol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Ergomar (ergotamine) Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
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Erivedge® (vismodegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
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Erleada ® (apalutamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Esbriet® (pirfenidone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Esbriet® (pirfenidone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Esperoct (antihemophilic factor [recombinant], glycopegylatedexei) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
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Esperoct (antihemophilic factor [recombinant], glycopegylatedexei) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
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Evekeo (amphetamine sulfate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.06.2020
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Evekeo ODT (amphetamine sulfate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
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Evzio (naloxone hydrochloride) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
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Exalgo (hydromorphone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Exforge - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
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Exjade® (deferasirox) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
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Extavia® (interferon β-1b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
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Ezallor Sprinkle (rosuvastatin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
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Fabior (tazarotene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Farydak (panobinostat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
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Fasenra® (benralizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Fasenra™ (benralizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Felbatol (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Fentanyl citrate powder - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Fentanyl Transdermal - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Fentora (fentanyl buccal tablet) - Prior Authorization / Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.14.2020
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Fentora (fentanyl buccal tablet) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Ferriprox® (deferiprone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
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Firazyr (icatibant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Firazyr® (icatibant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Firdapse® (amifampridine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Firdapse® (amifampridine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
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FIRST™-ProgesteroneVGS (progesterone vaginal suppository compounding kit) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
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Flolipid (simvastatin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
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Focalin (dexmethylphenidate) and Focalin XR (dexmethylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
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Follistim® AQ (follitropin beta) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
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Follistim® AQ (follitropin beta) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Fortamet (metformin extended-release, brand and generic) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
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Forteo™ (teriparatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Fortesta (topical andogens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Fycompa (perampanel) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Fycompa (perampanel) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Galafold™ (migalastat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Ganirelix Acetate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
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Gattex® (teduglutide [rDNA origin]) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
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Genotropin® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Genotropin® (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Gilenya®(fingolimod) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
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Gilotrif® (afatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Glatopa™ (glatiramer acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
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Gleevec® (imatinib mesylate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
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Gloperba (colchicine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
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 08.17.2020
-
Gonal-f RFF (follitropin alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
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 08.01.2020
-
Grastek (sublingual immunotherapy) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Grastek (sublingual Immunotherapy) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Haegarda (C1 esterase inhibitor Subcutaneous, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Haegarda - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Harvoni (ledipasvir/sofosbuvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Harvoni® (ledipasvir/sofosbuvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
Health Care Reform Breast Cancer Prevention Copay Reduction Tamoxifen - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
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/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
Hetlioz® (tasimelteon) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
HIV Pre-exposure Prophylaxis (PrEP) Zero Dollar Cost Share – generic tenofovir disoproxil fumarate 300 mg - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Humatrope® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Humatrope® (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Humira (adalimumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Humira® (adalimumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
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 06.12.2020
-
Ibrance® (palbociclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
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 06.12.2020
-
Ilumya™ (tildrakizumab-asmn) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
Imbruvica® (ibrutinib)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.19.2020
-
Inbrija® (levodopa inhalation powder) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Inbrija™ (levodopa inhalation powder) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
Increlex (mecasermin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
-
Increlex® (mecasermin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Infertility Medications (applies to Hawaii) - Prior Authorization/Regulatory - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
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
-
Invokana (canagliflozin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Iressa® (gefitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Isturisa® (osilodrostat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
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 06.01.2020
-
Jatenzo (testosterone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Jivi (antihemophilic factor [recombinant], PEGylated-aucl) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
Jivi (antihemophilic factor [recombinant], PEGylated-aucl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
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 06.12.2020
-
Juxtapid® (lomitapide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
-
Juxtapid™ (lomitapide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
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 06.12.2020
-
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 05.14.2020
-
Keppra and Keppra XR (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Kerydin (tavaborole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Keveyis® (dichlorphenamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
Kevzara® (sarilumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Kevzara®(sarilumab) Injection - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Kineret® (anakinra) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Kisqali® (ribociclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
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 04.16.2020
-
Korlym® (mifepristone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Kuvan® (sapropterin dihydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Lamictal and Lamictal XR (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Lamictal ODT (brand and generic) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
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/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Letairis® (ambrisentan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Leuprolide Acetate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Levemir (insulin detemir) - Prior Authorization - UnitedHealthcare Commercial Plans
Last Published 10.05.2020
-
Lidocaine patch (Lidoderm) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
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 06.01.2020
-
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 06.12.2020
-
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 10.01.2020
-
Lyrica - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Mavenclad® (cladribine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
-
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 06.01.2020
-
Mayzent® (siponimod) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
-
Mekinist® (trametinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Mektovi™ (binimetinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Menopur® (menotropins) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Menopur® (menotropins) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
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 03.30.2020
-
Minocycline extended-release tablet (generic Solodyn) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
Minolira (minocycline extended-release tablet) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
Mirvaso (brimonidine gel) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Morphabond ER (morphine sulfate extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Morphine Sulfate (generic MS Contin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Motegrity (prucalopride) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
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 06.12.2020
-
Mulpleta® (lusutrombopag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Multaq (dronedarone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Myalept (metreleptin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
Myalept® (metreleptin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
Mydayis (dextroamphetamine-amphetamine mixed salts) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Mysoline (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Mytesi™ (crofelemer) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
Naprosyn (naproxen) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
Natesto (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
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
-
Nayzilam (midazolam) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Nerlynx® (neratinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Neurontin (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
New & Therapeutic Equivalent Medications - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
New & Therapeutic Equivalent Medications Excluded Drug - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
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 04.17.2020
-
Nexletol (bempedoic acid) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Nexlizet (bempedoic acid/ezetimibe) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
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 10.22.2020
-
Nicotine Gum/Lozenge/Patch - Tobacco Cessation (Applies to NJ Fully Insured) - UnitedHealthcare Commercial Plans
Last Published 10.22.2020
-
Nicotrol Inhaler (nicotine inhalation system) - Tobacco Cessation (Applies to KY Fully Insured) - Supply Limit Override - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
Nicotrol Inhaler (nicotine inhalation system) - Tobacco Cessation (Applies to NJ Fully Insured) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
Nicotrol Inhaler (nicotine inhalation system) – Tobacco Cessation - Prior Authorization - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
Nicotrol NS (nicotine nasal spray) – Tobacco Cessation (Applies to KY Fully Insured) – Supply Limit Override - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
Nicotrol NS (nicotine nasal spray) – Tobacco Cessation (Applies to NJ Fully Insured) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
Nicotrol NS (nicotine nasal spray) – Tobacco Cessation - Prior Authorization - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
Ninlaro® (ixazomib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
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 04.17.2020
-
Noctiva (desmopressin acetate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
Non-Formulary Copay Adjustment Notification (applies to New Jersey) - Prior Authorization/Regulatory - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
NordiFlex® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
NordiFlex® (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Norditropin (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Norditropin® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Northera (droxidopa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
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 06.12.2020
-
Nucala® (mepolizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Nucynta ER (tapentadol extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Nuedexta (dextromethorphan/quinidine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Nuedexta (dextromethorphan/quinidine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Nuplazid (pimavanserin tartrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Nurtec ODT (rimegepant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Nutropin AQ® NuSpin™ (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Nutropin AQ® NuSpin™ (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Nutropin®, Nutropin AQ® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Nutropin®, Nutropin AQ® (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
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 03.30.2020
-
Ocaliva (obeticholic acid) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Ocaliva (obeticholic acid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Odactra (sublingual immunotherapy) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Odactra (sublingual immunotherapy) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Odomzo® (sonidegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Ofev® (nintedanib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Ofev® (nintedanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Olumiant® (baricitinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Olumiant® - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Omnitrope® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Omnitrope® (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Onfi (clobazam) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Onfi - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Opana ER (oxymorphone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Opioid Containing Cough & Cold Medicines PA/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.29.2019
-
Opsumit® (macitentan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Opsumit® (macitentan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
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 06.01.2020
-
Oralair (sublingual immunotherapy) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Orencia (abatacept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Orencia® (abatacept) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Orenitram™ (treprostinil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Orenitram™ (treprostinil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Orfadin® (nitisinone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
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 07.09.2020
-
Otezla® (apremilast) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
Ovidrel® (choriogonadotropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Oxbryta™ (voxelotor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
-
Oxbryta™ (voxelotor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Oxervate (cenegermin-bkbj) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
Oxervate™ (cenegermin-bkbj) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
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 10.01.2020
-
OxyContin (oxycodone controlled-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Ozobax (baclofen) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
Palforzia [Peanut (Arachis hypogaea) Allergen Powder-dnfp] - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Palynziq™ - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Palynziq™ (pegvaliase-pqpz) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
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
-
Pemazyre™ (pemigatini) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
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 03.30.2020
-
Pomalyst® (pomalidomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
Praluent (alirocumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Praluent™ (alirocumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
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 04.17.2020
-
Prevymis™ (letermovir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Procentra (dextroamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Procysbi® (cysteamine bitartrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Progesterone bulk powder - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
Promacta® (eltrombopag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Provigil (modafanil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
-
Prudoxin (doxepin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
-
Pulmozyme® (dornase alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
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 04.17.2020
-
Qinlock™ (ripretinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
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 10.01.2020
-
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 06.01.2020
-
Ragwitek (sublingual immunotherapy) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Ravicti™ (glycerol phenylbutyrate oral liquid) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
Ravicti™ (glycerol phenylbutyrate oral liquid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
Rebif® (interferon β-1a) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
-
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 10.01.2020
-
Repatha™ (evolocumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
Repatha™ (evolocumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
Restasis (cyclosporine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
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 08.17.2020
-
Revatio® (sildenafil citrate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Revatio® Solution (sildenafil citrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Revlimid (lenalidomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Rexulti (brexpiprazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Reyvow (lasmiditan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Rhofade (oxymetazoline cream) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Rinvoq™ (upadacitinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
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 08.17.2020
-
Ruconest (C1 esterase inhibitor recombinant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Ruconest® (C1 esterase inhibitor [recombinant]) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Ruzurgi® (amifampridine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Rydapt™ (midostaurin) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Sabril (vigabatrin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Saizen® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Saizen® (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Samsca (tolvaptan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
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 04.16.2020
-
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 06.12.2020
-
Serostim® (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
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 06.12.2020
-
Siliq™ (brodalumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
Simponi® (golimumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Simponi® (golimumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Skyrizi™ (risankizumab-rzaa) injection - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Skyrizi™ (risankizumab-rzaa) injection - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Slynd (drospirenone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
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 10.01.2020
-
Solodyn (generic minocycline extended-release tablet) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
Somavert® (pegvisomant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Somavert®(pegvisomant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Sotylize (sotalol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
Sovaldi® (sofosbuvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Sovaldi® (sofosbuvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
Spravato™ (esketamine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
Spravato™ (esketamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Spritam (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Sprycel® (dasatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Sprycel®(dasatinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Stelara™ (ustekinumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Stelara™ (ustekinumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.04.2019
-
Stendra (avanafil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Stivarga® (regorafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Strensiq® (asfotase alfa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
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 10.01.2020
-
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 03.30.2020
-
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 10.01.2020
-
Sutent® (sunitinib malate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
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 10.01.2020
-
Symproic (maldemedine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.25.2020
-
Syndros (dronabinol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
Synribo® (omacetaxine)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Syprine (trientine hydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Tabrecta™ (capmatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Tafinlar® (dabrafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
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 08.17.2020
-
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 10.01.2020
-
Taltz™ (ixekizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
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/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Tazorac® (tazarotene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Tazverik™ (tazemetostat)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Tecfidera™ (dimethyl fumarate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
-
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) - Pror Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
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 08.01.2020
-
Tibsovo® (ivosidenib) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Tiglutik (riluzole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
Tirosint-Sol (levothyroxine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
TOBI™ Nebulizer Solution and TOBI® Podhaler™ (tobramycin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
Topamax (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Tracleer® (bosentan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Tracleer® (bosentan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Tremfya (guselkumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Tremfya® (guselkumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
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 10.01.2020
-
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 10.01.2020
-
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
-
Tukysa™ (tucatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
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/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Tyvaso® (treprostinil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Ubrelvy (ubrogepant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Uptravi® (selexipag) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2020
-
Uptravi® (selexipag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Valchlor® (mechlorethamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
-
Valtoco (diazepam) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
-
Vanatol LQ (butalbital, acetaminophen and caffeine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
Vascepa® (icosapent ethyl) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
Vascepa® (icosapent ethyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
Vecamyl (mecamylamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
Veltassa (patiromer) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Venclexta™ (venetoclax) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Ventavis (iloprost) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
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 06.12.2020
-
Verzenio® (abemaciclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020
-
Viberzi (eluxadoline) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Viekira Pak (ombitasvir, paritaprevir, ritonavir, dasabuvir tablets) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
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 10.01.2020
-
Vimpat (lacosamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Vitrakvi® (larotrectinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
-
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 10.01.2020
-
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
-
Vumerity™ (diroximel fumarate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
-
Vumerity™ (diroximel fumarate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
-
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 03.30.2020
-
Vyndamax™ (tafamidis)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
-
Vyndaqel® (tafamidis meglumine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
-
Vyndaqel® (tafamidis meglumine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
-
Vyvanse (lisdexamfetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
-
Wakix® (pitolisant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Wakix® (pitolisant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2020
-
Xalkori® (crizotinib)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
Xatmep (methotrexate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
Xeljanz®/Xeljanz® XR (tofacitinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Xeljanz®/Xeljanz® XR (tofacitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
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 08.17.2020
-
Xifaxan (rifaximin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Xiidra (lifitegrast 5% ophthalmic solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Xiidra®(lifitegrast 5% ophthalmic solution) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
-
Ximino (minocycline extended-release capsule) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
-
Xospata® (gilteritinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
-
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 06.12.2020
-
Xtandi® (enzalutamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
-
Xuriden® (uridine triacetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
-
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 10.01.2020
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Xyrem (sodium oxybate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
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Xyrem® (sodium oxybate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
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Yonsa (abiraterone acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.16.2020
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Yupelri (revefenacin inhalation solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Zegerid (omeprazole, sodium bicarbonate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.17.2020
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Zejula™ (niraparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Zelboraf™ (vemurafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2020
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Zelnorm (tegaserod) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2020
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Zelnorm (tegaserod) - Prior Authorization/Notification - UnitedHealthcare Commercial
Last Published 02.25.2020
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Zenzedi (dextroamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.30.2019
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Zepatier (elbasvir, grazoprevir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Zepatier (elbasvir, grazoprevir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
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Zohydro ER (hydrocodone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Zomacton® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Zomacton® (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Zonalon (doxepin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.30.2020
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Zonegran (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2020
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Zorbtive® (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Zorbtive® (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Zovirax Ointment (acyclovir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.26.2019
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ZTLido - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.12.2020
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Zurampic (lesinurad) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.27.2019
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Zydelig® (idelalisib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.27.2019
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Zykadia™ (ceritinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.17.2020
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Zytiga™ (abiraterone acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2020