Clinical Pharmacy Prior Authorization, Notification and Medical Necessity Requirements - Commercial

Abilify MyCite (aripiprazole tablet with sensor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Absorica* (isotretinoin), Absorica LD* (isotretinoin micronized) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Abstral (fentanyl sublingual tablets) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Abstral (fentanyl sublingual tablets)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Actemra® (tocilizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Actemra® (tocilizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Acthar Gel® (Repository corticotropin injection) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Acthar Gel® (Repository corticotropin injection) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Acthar Gel® (Repository corticotropin injection) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Acthar Gel® (Repository corticotropin injection) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Actimmune® (interferon gamma-1b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Actiq (brand only) (fentanyl transmucosal lozenge) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Actiq (fentanyl transmucosal lozenge) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Adbry™ (tralokinumab-ldrm) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Adbry™ (tralokinumab-ldrm) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Adcirca® (tadalafil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Adcirca® (tadalafil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Addyi (flibanserin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Adempas® (riociguat) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Adempas® (riociguat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Adlyxin (lixisenatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Adynovate (antihemophilic factor [recombinant], pegylated)- Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Afinitor (everolimus) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Afrezza (insulin human) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Afrezza (insulin human) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Afstyla (antihemophilic factor [recombinant], single chain) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Afstyla® (antihemophilic factor [recombinant], single chain) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Aimovig (erenumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Aimovig (erenumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Ajovy (fremanezumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Ajovy (fremanezumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Aklief® (trifarotene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.17.2020

Albenza (albendazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Albuterol tablets - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Alecensa® (alectinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Alkindi Sprinkle (hydrocortisone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2021

Alkindi Sprinkle (hydrocortisone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Altreno® (tretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Alunbrig® (brigatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Amitiza (lubiprostone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Amitiza® (lubiprostone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Amlodipine/valsartan/hydrochlorothiazide (generic Exforge HCT) - Prior Authorization - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Ampyra® (dalfampridine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Amzeeq (minocycline 4% topical foam) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Androderm - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Androgel - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Apokyn® (apomorphine) injection - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Apokyn® (apomorphine) injection - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Aptiom (eslicarbazepine acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Aptiom (eslicarbazepine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Arazlo®(tazarotene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Arcalyst® (rilonacept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Arikayce® (amikacin liposome inhalation suspension) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Arikayce® (amikacin liposome inhalation suspension) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Arymo ER (morphine sulfate extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.12.2020

Atralin™ (tretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Aubagio® (teriflunomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Austedo® (deutetrabenazine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Austedo® (deutetrabenazine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Avinza (morphine sulfate controlled-release capsules) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Avita® (tretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Avonex® (interferon β-1a) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Axiron - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Ayvakit™ (avapritinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Bafiertam™ (monomethyl fumarate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Balversa® (erdafitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Banzel (rufinamide) - Prior Authorization/Notification - UnitedHealthcare Commerical Plans

Last Published 12.13.2021

Banzel - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Belbuca (buprenorphine hydrochloride film) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Benlysta® (belimumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Benznidazole - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

benzphetamine - Prior Authorization – California, Maryland, New Mexico and New York Regulatory Program - Weight Loss - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

benzphetamine – California, Maryland and New York Regulatory Program - Weight Loss - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Berinert® (C1 esterase inhibitor [human]) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Berinert® (C1 esterase inhibitor, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Besremi (ropeginterferon alfa-2b-njft) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Betaseron® (interferon β-1b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Bethkis® Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Bonjesta (doxylamine/pyridoxine extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Bosulif® (bosutinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Braftovi® (encorafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Brexafemme (ibrexafungerp) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Briviact (brivaracetam) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Briviact (brivaracetam) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Bronchitol® (mannitol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Brukinsa™ (zanubrutinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Bunavail - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Butrans (buprenorphine patch, extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Bydureon (exenatide extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Bydureon BCise (exenatide extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Byetta (exenatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Bylvay (odevixibat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Bylvay™ (odevixibat) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Cablivi® (caplacizumab-yhdp) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Cabometyx® (cabozantinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Calquence® (acalabrutinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Caplyta (lumateperone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Caplyta (lumateperone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Caplyta (lumateperone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Caprelsa® (vandetanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Carafate (sucralfate) suspension - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 01.21.2022

Carafate (sucralfate) suspension - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Carbaglu® (carglumic acid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Cardiovascular Disease Prevention Prior Authorization - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Carospir (spironolactone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Cayston® (aztreonam for inhalation solution) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Cequa™ (cyclosporine 0.09% ophthalmic solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Cequa™ (cyclosporine 0.09% ophthalmic solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Cequa™ (cyclosporine 0.09% ophthalmic solution) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Cequa™ (cyclosporine 0.09% ophthalmic solution)*, Restasis® (cyclosporine 0.05% ophthalmic emulsion), Restasis MultiDose (cyclosporine 0.05% ophthalmic emulsion)*, Tyrvaya™ (varenicline nasal spray), Xiidra® (lifitegrast 5% ophthalmic solution) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Cequa™ (cyclosporine 0.09% ophthalmic solution), Restasis® (cyclosporine 0.05% ophthalmic emulsion) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Cerdelga® (eliglustat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Cetrotide® (cetrorelix acetate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Cetrotide® (cetrorelix acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Chantix (Varenicline) - Tobacco Cessation (applies to New Jersey Fully Insured) - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Chantix (varenicline) - Tobacco Cessation (applies to Kentucky Fully Insured) - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Chantix (varenicline) - Tobacco Cessation - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

chlorpromazine oral solution - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Cholbam (cholic acid) - Prior Authorization/Notification - UnitedHealthcare Comemercial Plans

Last Published 06.01.2022

Cibinqo™ (abrocitinib) tablets - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Cimzia® (certolizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Cimzia® (certolizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Cinryze® (C1 esterase inhibitor, human) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Cinryze® (C1 esterase inhibitor, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Clomid (clomiphene citrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Colchicine tablet (Colcrys authorized generic) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Cometriq® (cabozantinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Compounds and Bulk Powders - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2021

Compounds and Bulk Powders - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Continuous Glucose Monitors, sensors and transmitters (all brands) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Contrave (naltrexone and bupropion) - Prior Authorization – California, Maryland, New Mexico and New York Regulatory Program - Weight Loss - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Copaxone® (glatiramer acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Copiktra® (duvelisib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Corlanor® (ivabradine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Cosentyx™ (secukinumab) prefilled syringe or Sensoready pen - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Cosentyx™ (secukinumab) prefilled syringe or Sensoready pen - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Cotellic® (cobimetinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Cystadrops (cysteamine) ophthalmic solution - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Cystaran® (cysteamine) ophthalmic solution - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Daliresp® (roflumilast) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Daraprim® (pyrimethamine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Daurismo™ (glasdegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2021

Daurismo™ (glasdegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Depakote and Depakote ER - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.17.2022

Depakote, Depakote ER - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Descovy® (emtricitabine/tenofovir alafenamide) - Colorado - PA/Medical Necessity - UnitedHealthcare Commerical Plans

Last Published 06.01.2022

Descovy® (emtricitabine/tenofovir alafenamide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Devices - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Diabetic Meters and Test Strips Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Diabetic Meters and Test Strips Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Diacomit (stiripentol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Diagnostic Agents - Prior Authorization/Medical Necessity - Oxford

Last Published 04.14.2022

Diclegis (doxylamine/pyridoxine delayed-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

diethylpropion - Prior Authorization – California, Maryland, New Mexico and New York Regulatory Program - Weight Loss - UnitedHealthcare Commercial Plans

Last Published 04.28.2022

Differin® (adapalene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Digital Applications - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Dihydroergotamine nasal spray (Migranal) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

dimethyl fumarate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Dimethyl fumarate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Dojolvi™ (triheptanoin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.08.2021

Dojolvi™ (triheptanoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Dolophine (methadone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.12.2020

Doptelet® (avatrombopag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Drizalma Sprinkle (duloxetine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Duopa (carbidopa/levodopa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Dupixent® (dupilumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Dupixent®(dupilumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Duragesic (fentanyl transdermal) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Egrifta SV™ (tesamorelin for injection) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Eloctate [antihemophilic factor (recombinant), Fc fusion protein] - Prior Authorization/Medical Necessity - UnitedHealth Commercial Plans

Last Published 12.01.2021

Eloctate® [antihemophilic factor (recombinant), Fc fusion protein] - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Emflaza® (deflazacort) - PA-Notification - UnitedHealthcare Commerical Plans

Last Published 02.01.2022

Emflaza® (deflazacort) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Emgality (galcanezumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Emgality (galcanezumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Empaveli™ (pegcetacoplan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Empaveli™ (pegcetacoplan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.17.2022

Emverm (mebendazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Enbrel® (etanercept) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Enbrel® (etanercept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Endari (L-glutamine Powder for Solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 01.31.2022

Endari (L-glutamine Powder for Solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Enspryng™ (satralizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Enspryng™ (satralizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Entresto (valsartan-sacubitril) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Entresto (valsartan-sacubitril) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Envarsus XR™ (tacrolimus extended-release tablets) - Prior Authorization/Non-Formulary - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Envarsus XR™ (tacrolimus extended-release tablets) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.08.2021

Epaned (enalapril) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Epclusa (sofosbuvir/velpatasvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Epclusa (sofosbuvir/velpatasvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Epidiolex (cannabidiol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Epidiolex (cannabidiol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Erivedge® (vismodegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Erleada® (apalutamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Esbriet® (pirfenidone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Esbriet® (pirfenidone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Esperoct (antihemophilic factor [recombinant], glycopegylated-exei) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Esperoct (antihemophilic factor [recombinant], glycopegylated-exei) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Evrysdi (risdiplam) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Evrysdi (risdiplam) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Exalgo (hydromorphone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Exjade® (deferasirox) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Exkivity™ (mobocertinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.07.2022

Exservan (riluzole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Extavia® (interferon β-1b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Ezallor Sprinkle (rosuvastatin)- Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Fabior™ (tazarotene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Farydak® (panobinostat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2021

Fasenra™ (benralizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Felbatol - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Fentanyl Citrate - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.08.2021

fentanyl citrate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Fentanyl citrate bulk powder - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

fentanyl transdermal - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Fentora (fentanyl buccal tablet) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Fentora (fentanyl buccal tablet) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Ferriprox® (deferiprone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Fiasp (insulin aspart) - Prior Authorization/Non-Formulary - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Fintepla (fenfluramine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Fintepla (fenfluramine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Firazyr® (icatibant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Firazyr® (icatibant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Firdapse® (amifampridine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Firdapse® (amifampridine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2021

Firdapse® (amifampridine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Flolipid (simvastatin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Follistim AQ (follitropin beta) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Follistim® AQ (follitropin beta) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Fortamet (metformin extended-release, brand and generic) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Forteo® (teriparatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Forteo™ (teriparatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2021

Fortesta - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Fotivda® (tivozanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Fuzeon® (enfuvirtide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2021

Fycompa (perampanel) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Fycompa (perampanel) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Galafold® (migalastat) (migalastat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

ganirelix acetate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Gattex® (teduglutide [rDNA origin]) - PA-Notification - UnitedHealthcare Commerical Plans

Last Published 02.01.2022

Gattex® (teduglutide [rDNA origin]) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Gavreto™ (pralsetinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Genotropin - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Genotropin® - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Genotropin® - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Gilenya® (fingolimod) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Gilotrif® (afatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Glatopa™ (glatiramer acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Gleevec® (imatinib mesylate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Gloperba (colchicine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Glucophage XR (metformin extended-release, brand only) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.08.2021

Glumetza (metformin extended-release, brand and generic) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Gonal-f™ (follitropin alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Gonal-f™ (follitropin alfa), Gonal-f™ RFF (follitropin alfa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Gonal-f™ RFF (follitropin alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Gonococcal Ophthalmia Neonatorum Prevention Prior Authorization/Regulatory - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Grastek (Timothy grass pollen allergen extract) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Grastek (Timothy grass pollen allergen extract) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Guardian Connect Sensor and Transmitter for Continuous Glucose Monitoring - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Haegarda® (C1 esterase inhibitor Subcutaneous, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plan

Last Published 10.01.2021

Haegarda® (C1 esterase inhibitor, human) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Harvoni® (ledipasvir/sofosbuvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Health Care Reform Breast Cancer Prevention Copay Reduction - Tamoxifen Prior Authorization/Notification -UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Hemlibra® (emicizumab-kxwh) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Hemlibra® (emicizumab-kxwh) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Hetlioz, Hetlioz LQ (tasimelteon) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.19.2021

Hetlioz®, Hetlioz LQ (tasimelteon) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.14.2022

HIV Medications with Pre-exposure Prophylaxis (PrEP) Use Zero Dollar Cost Share for California - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 01.07.2021

HIV Medications with Pre-exposure Prophylaxis (PrEP) Use Zero Dollar Cost Share- California-PA/Notification-UnitedHealthcare Commerical Plans

Last Published 06.01.2022

HIV Pre-exposure Prophylaxis (PrEP) Zero Dollar Cost Share – generic tenofovir disoproxil fumarate - Prior Authorization - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Humatrope® - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Humatrope® - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Humatrope® - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Humira® (adalimumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Humira® (adalimumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Hycamtin® (topotecan hydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

hydromorphone extended-release (generic Exalgo) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Hysingla ER (hydrocodone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Ibrance® (palbociclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Iclusig® (ponatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Idhifa® (enasidenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Ilumya™ (tildrakizumab-asmn) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Ilumya™ (tildrakizumab-asmn) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Imbruvica® (ibrutinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Imcivree (setmelanotide) - Prior Authorization – California, Maryland, New Mexico and New York Regulatory Program - Weight Loss - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Impavido (miltefosine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Inbrija® (levodopa inhalation powder) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Inbrija® (levodopa inhalation powder) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Increlex - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.09.2022

Increlex® - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Increlex®- Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Indocin (indomethacin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Infertility Medications (applies to Hawaii) Prior Authorization/Regulatory - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Ingrezza® (valbenazine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Ingrezza® (valbenazine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Inlyta® (axitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Inqovi® (decitabine and cedazuridine) tablet - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Inrebic® (fedratinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Interim New Product Coverage Criteria - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Intrarosa (prasterone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Intron A (interferon alfa-2b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Invokana (canagliflozin) - Non-Formulary - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Invokana (canagliflozin) - Prior Authorization - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Iressa® (gefitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Isturisa® (osilodrostat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Ivermectin - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.12.2021

Ixinity [coagulation factor IX (recombinant)] - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Jadenu® (deferasirox) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Jakafi® (ruxolitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Jatenzo - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Jivi (antihemophilic factor [recombinant], PEGylated-aucl) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Jublia (efinaconazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Juxtapid® (lomitapide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Jynarque (tolvaptan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Kadian (morphine sulfate sustained-release capsules) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Kalydeco® (ivacaftor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Kalydeco® (ivacaftor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Katerzia (amlodipine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Keppra, Keppra XR - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Kerendia (finerenone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Kerendia (finerenone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Kerydin (tavaborole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Kesimpta (ofatumumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Kevzara® (sarilumab) Injection - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Kevzara® (sarilumab) Injection - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Kineret® (anakinra) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Kisqali® (ribociclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Kisqali® Femara® Co-Pack (ribociclib/letrozole) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Korlym® (mifepristone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Koselugo™ (selumetinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Kuvan® (sapropterin dihydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Kynmobi™ (apomorphine) sublingual film - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Kynmobi™ (apomorphine) sublingual film - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Lamictal and Lamictal XR (brand and generic) - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Lamictal ODT (brand and generic) - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Lampit (nifurtimox) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Lazanda (fentanyl nasal spray) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Lazanda (fentanyl nasal spray) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Lenvima® (lenvatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.24.2022

Letairis® (ambrisentan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Letairis® (ambrisentan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

leuprolide acetate (bulk powder, 1 mg/0.2 mL injection, Eligard®) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Levemir (insulin detemir) - Prior Authorization/Non-Formulary - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Lidocaine Patch (Lidoderm) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Linzess® (linaclotide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Lithobid - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Livmarli™ (maralixibat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Lokelma (sodium zirconium cyclosilicate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Lonhala Magnair (glycopyrrolate inhalation solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Lonsurf® (trifluridine/tipiracil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Lorbrena® (lorlatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Lotronex (alosetron) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Lucemyra (lofexidine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Lumakras™ (sotorasib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Lupkynis (voclosporin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.18.2021

LupkynisTM (voclosporin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.15.2022

Lybalvi (olanzapine/samidorphan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Lynparza® (olaparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Lyrica - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Mavenclad® (cladribine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Mavyret (glecaprevir/pibrentasvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Mavyret™ (glecaprevir/pibrentasvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Mayzent (siponimod)® - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Mekinist® (trametinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Mektovi® (binimetinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Menopur® (menotropins) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Menopur® (menotropins) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Methadone - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Migranal (Dihyroergotamine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Minolira (minocycline extended-release tablet - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Mirvaso (brimonidine gel) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

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

morphine sulfate controlled-release capsules (generic Avinza) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.13.2021

morphine sulfate sustained-release capsules (generic Kadian) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Motegrity (prucalopride) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Motegrity (prucalopride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Movantik (naloxegol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Movantik®*(naloxegol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

MS Contin (morphine sulfate controlled-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Mulpleta® (lusutrombopag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Multaq® (dronedarone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.17.2022

Myalept® (metreleptin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Myalept® (metreleptin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Mycapssa® (octreotide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Mycapssa™ (octreotide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

MyFembree (relugolix and estradiol hemihydrate/norethindrone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Mysoline - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Mytesi™ (crofelemer) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Naprosyn (naproxen) suspension - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Natesto - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Natpara® (parathyroid hormone analog) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Natpara® (parathyroid hormone analog) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Nayzilam (midazolam) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Nerlynx® (neratinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Neurontin - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

New and Therapeutic Equivalent Medications - Excluded Drug - UnitedHealthcare Commercial Plans

Last Published 05.05.2022

New and Therapeutic Equivalent Medications - Prior Authorization - UnitedHealthcare Commercial Plans

Last Published 05.05.2022

Nexavar® (sorafenib tosylate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Nexium for suspension (esomeprazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 01.21.2022

Nexium for suspension (esomeprazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Nexletol (bempedoic acid) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Nexlizet (bempedoic acid/ezetimibe) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Nicotrol Inhaler (nicotine inhalation system) - Tobacco Cessation (applies to New Jersey Fully Insured) - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Nicotrol Inhaler (nicotine inhalation system) - Tobacco Cessation (applies to Kentucky Fully Insured) - UnitedHealthcare Commercial Plans- UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Nicotrol Inhaler (nicotine inhalation system) - Tobacco Cessation - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Nicotrol NS (nicotine nasal spray) - Tobacco Cessation (applies to New Jersey Fully Insured) - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Nicotrol NS (nicotine nasal spray) - Tobacco Cessation - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Nicotrol NS (nicotine nasal spray) – Tobacco Cessation (Applies to KY Fully Insured) – Supply Limit Override - UnitedHealthcare Commercial Plans

Last Published 10.28.2021

Ninlaro® (ixazomib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Nityr™ (nitisinone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Nocdurna (desmopressin acetate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

NordiFlex® - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

NordiFlex® - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

NordiFlex®- Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Norditropin - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Norditropin® - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Norditropin® - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Northera (droxidopa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Nourianz (istradefylline) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Novarel® (chorionic gonadotropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Nubeqa® (darolutamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Nucala® (mepolizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Nucala® (mepolizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Nucynta ER (tapentadol extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Nuedexta (dextromethorphan/quinidine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Nuedexta (dextromethorphan/quinidine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Nuplazid (pimavanserin tartrate) - PA-Notification - UnitedHealthcare Commerical Plans

Last Published 02.01.2022

Nurtec ODT (rimegepant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Nurtec ODT (rimegepant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

NuSpin™ - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Nutropin AQ® NuSpin™ - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Nutropin AQ® NuSpin™ - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Nutropin AQ® NuSpin™ - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Nutropin®- Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Nuvigil - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2021

Ocaliva (obeticholic acid) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Ocaliva (obeticholic acid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Odactra (Dermatophagoides farinae/Dermatophagoides pteronyssinus allergen extract) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Odactra (Dermatophagoides farinae/Dermatophagoides pteronyssinus allergen extract) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Odomzo® (sonidegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Ofev® (nintedanib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Ofev® (nintedanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Olumiant® (baricitinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Olumiant® (baricitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Omnipod 5 - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.20.2022

Omnipod 5 - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.20.2022

Omnitrope® - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Omnitrope® - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Omnitrope® - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Onfi (clobazam) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Onfi - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Onureg® (azacitidine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Opana ER (oxymorphone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.12.2020

Opioid-containing cough medicines - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Opsumit® (macitentan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Opsumit® (macitentan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Opzelura™ (ruxolitinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.08.2022

Opzelura™ (ruxolitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Oral Oncology Agents - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Oralair (Sweet Vernal, Orchard, Perennial Rye, Timothy, and Kentucky Blue Grass Mixed Pollens allergen extract) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Oralair (Sweet Vernal, Orchard, Perennial Rye, Timothy, and Kentucky Blue Grass Mixed Pollens allergen extract) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2021

Orencia® (abatacept) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Orencia® (abatacept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Orenitram™ (treprostinil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Orenitram™ (treprostinil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Orfadin® (nitisinone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Orgovyx™ (relugolix) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Oriahnn (elagolix and estradiol/norethindrone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Orilissa (elagolix) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Orkambi™ (lumacaftor/ivacaftor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Orkambi™ (lumacaftor/ivacaftor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Orladeyo (berotralstat) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Orladeyo (berotralstat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Osphena (ospemifene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.07.2022

Otezla® (apremilast) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Ovidrel® (choriogonadotropin alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Ovidrel® (choriogonadotropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2020

Oxbryta™ (voxelotor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2021

Oxbryta™ (voxelotor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Oxbryta™ (voxelotor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2021

Oxervate (cenegermin-bkbj) ophthalmic solution - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Oxervate (cenegermin-bkbj) ophthalmic solution - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Oxistat (oxiconazole) cream - PA-Medical Necessity - UnitedHealthcare Commerical Plans

Last Published 02.01.2022

OxyContin (oxycodone controlled-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Ozempic (semaglutide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Ozobax (baclofen) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Palforzia [Peanut (Arachis hypogaea) Allergen Powder-dnfp] - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Palforzia [Peanut (Arachis hypogaea) Allergen Powder-dnfp] - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Palynziq ( pegvaliase-pqpz) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Palynziq ( pegvaliase-pqpz) -Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Pegasys (peginterferon alfa-2a) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Pemazyre®(pemigatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

phentermine (all brand products including Adipex-P and Lomaira) - Prior Authorization – California, Maryland, New Mexico an New York Regulatory Program - Weight Loss - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Phexxi (lactic acid, citric acid, and potassium bitartrate) vaginal gel - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Piqray® (alpelisib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Plegridy™ (peginterferon β-1a) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Pomalyst® (pomalidomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Ponvory™ (Ponesimod) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.07.2022

Praluent® (alirocumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 09.01.2021

Praluent® (alirocumab)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Pregnyl® (chorionic gonadotropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Prevacid SoluTab (lansoprazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Prevymis™ (letermovir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Procysbi® (cysteamine bitartrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.16.2021

Progesterone bulk powder - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.09.2020

Prograf Granules (tacrolimus) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Promacta® (eltrombopag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Provigil - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2021

Prudoxin (doxepin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Prudoxin (doxepin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Pulmozyme® (dornase alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Purixan (mercaptopurine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Qbrelis (lisinopril) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Qdolo (tramadol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Qelbree (viloxazine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Qinlock™ (ripretinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Qsymia (phentermine and topiramate extended-release) - Prior Authorization – California, Maryland, New Mexico and New York Regulatory Program - Weight Loss - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Qulipta (atogepant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Qulipta (atogepant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Ragwitek (Short Ragweed Pollen allergen extract) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Ragwitek (Short Ragweed Pollen allergen extract) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Ravicti™ (glycerol phenylbutyrate oral liquid) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Ravicti™ (glycerol phenylbutyrate oral liquid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Rebif® (interferon β-1a) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Recorlev® (levoketoconazole) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Regranex® (becaplermin gel) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Relistor (methylnaltrexone bromide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Renvela (sevelamer carbonate) powder for suspension - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Repatha® (evolocumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 09.01.2021

Repatha® (evolocumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Restasis® (cyclosporine 0.05% ophthalmic emulsion), Restasis MultiDose (cyclosporine 0.05% ophthalmic emulsion) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Restasis® (cyclosporine 0.05% ophthalmic emulsion), Restasis MultiDose (cyclosporine 0.05% ophthalmic emulsion) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Retevmo™ (selpercatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Retin-A® (tretinoin) [brand only], Retin-A Micro® (tretinoin microspheres) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Revatio® Solution (sildenafil citrate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Revatio® Solution (sildenafil citrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Revlimid® (lenalidomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Rexulti (brexpiprazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Reyvow (lasmiditan) - Prior Authorization-Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Reyvow (lasmiditan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Rezurock™ (belumosudil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Rhofade (oxymetazoline cream) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Rinvoq™ (upadacitinib) extended-release tablets - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Rinvoq™ (upadacitinib) extended-release tablets - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Rozlytrek™ (entrectinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Rubraca® (rucaparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Ruconest® (C1 esterase inhibitor [recombinant]) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Ruconest® (C1 esterase inhibitor [recombinant]) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Rukobia (fostemsavir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Ruzurgi® (amifampridine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Rybelsus (semaglutide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Rydapt®(midostaurin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Sabril (vigabatrin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Sabril - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Saizen®- Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Saizen®- Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Samsca (tolvaptan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Sandostatin® (octreotide acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Saxenda (liraglutide) - Prior Authorization – California, Maryland, New Mexico and New York Regulatory Program - Weight Loss - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Scemblix® (asciminib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Selzentry® (maraviroc) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Sensipar (cinacalcet) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Serostim® - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Serostim® - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Signifor® (pasireotide diaspartate) - Prior Authorization/Notification - UnitedHealth Commercial Plans

Last Published 12.01.2021

Siliq (brodalumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Siliq™ (brodalumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Simponi® (golimumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Simponi® (golimumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.17.2022

Skyrizi® (risankizumab-rzaa) injection - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Skyrizi® (risankizumab-rzaa) injection - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Skytrofa™ - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Slynd (drospirenone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Slynd (drospirenone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Sodium phenylbutyrate (Buphenyl™) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Solaraze (diclofenac 3% gel) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Solodyn (minocycline extended-release tablet) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Somavert® (pegvisomant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Somavert® (pegvisomant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Sotylize (sotalol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Sovaldi® (sofosbuvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Sovaldi® (sofosbuvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Spravato™ (esketamine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Spravato™ (esketamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Sprycel® (dasatinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Sprycel® (dasatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Stelara™ (ustekinumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Stelara™ (ustekinumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Stendra (avanafil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Stivarga® (regorafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Strensiq® (asfotase alfa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Strensiq™ (asfotase alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Striant (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2020

Stromectol (ivermectin) oral dosage form - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Suboxone - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Subsys (fentanyl sublingual spray) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Subsys (fentanyl sublingual spray) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Sucraid (sacrosidase) oral solution - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2021

Sucraid (sacrosidase) oral solution - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Sunosi™ (solriamfetol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Sunosi™ (solriamfetol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Sutent® (sunitinib malate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Symdeko® (tezacaftor/ivacaftor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Symdeko® (tezacaftor/ivacaftor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Sympazan (clobazam) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Symproic (naldemedine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Syndros (dronabinol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Synribo® (omacetaxine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Syprine® (trientine hydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Tabrecta™ (capmatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Tafinlar® (dabrafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Tagrisso™ (osimertinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Takhzyro™ (lanadelumab-flyo) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Takhzyro™ (lanadelumab-flyo) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Taltz (ixekizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Taltz® (ixekizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Talzenna™ (talazoparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Tarceva® (erlotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Tarpeyo (budesonide delayed-release capsules) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Tasigna® (nilotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Tasmar® (tolcapone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Tavalisse (fostamatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Tavneos™ (avacopan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Tazorac (tazarotene) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Tazorac® (tazarotene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Tazverik®(tazemetostat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Tecfidera™ (dimethyl fumarate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Tegsedi™ (inotersen) - PA-Medical Necessity - UnitedHealthcare Commerical Plans

Last Published 02.01.2022

Tegsedi™ (inotersen) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Temodar® (temozolomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Tepmetko® (tepotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Testim - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Tetrabenazine (Xenazine®) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Thalomid® (thalidomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Tibsovo® (ivosidenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Tiglutik (riluzole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Tirosint-Sol (levothyroxine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

TOBI™ Nebulizer Solution and TOBI® Podhaler™ - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2021

TOBI™ Nebulizer Solution and TOBI® Podhaler™ - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Tobramycin solution for inhalation - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Topamax - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Topical Products - NJ & NY - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Tracleer® (bosentan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Tracleer® (bosentan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Tremfya® (guselkumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Tremfya® (guselkumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Trikafta® (elexacaftor/tezacaftor/ivacaftor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 09.07.2021

Trikafta® (elexacaftor/tezacaftor/ivacaftor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Trileptal - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Trintellix (vortioxetine) - Prior Authorization - UnitedHealthcare Commercial Plans

Last Published 08.10.2018

Trudhesa (dihydroergotamine nasal spray) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Trulance (plecanatide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Trulance (plecanatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Trulicity (dulaglutide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Truseltiq™ (infigratinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Tukysa™ (tucatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Turalio® (pexidartinib)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Tykerb® (lapatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Tymlos™ (abaloparatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Tyrvaya™ (varenicline nasal spray) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Tyrvaya™ (varenicline nasal spray) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Tyvaso® (treprostinil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Tyvaso® (treprostinil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Ubrelvy (ubrogepant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Ubrelvy (ubrogepant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Ukoniq™ (umbralisib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 01.28.2022

Upneeq (oxymetazoline) 0.1% ophthalmic solution - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2021

Upneeq (oxymetazoline) 0.1% ophthalmic solution - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Uptravi® (selexipag) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Uptravi® (selexipag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Valchlor® gel for topical use (mechlorethamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Valtoco (diazepam) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Vanatol LQ (butalbital, acetaminophen and caffeine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Vascepa® (icosapent ethyl) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Vascepa® (icosapent ethyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Vecamyl® (mecamylamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Veltassa (patiromer) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Venclexta (venetoclax) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Ventavis® (iloprost) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Ventavis® (iloprost) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Verquvo (vericiguat) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Verquvo (vericiguat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Verzenio® (abemaciclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 01.13.2022

Verzenio® (abemaciclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Viberzi (eluxadoline) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Victoza (liraglutide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Viekira Pak (ombitasvir, paritaprevir, and ritonavir tablets) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2021

Viekira Pak (ombitasvir, paritaprevir, and ritonavir tablets) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Viekira Pak™ (ombitasvir, paritaprevir, and ritonavir tablets; dasabuvir tablets) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Vimpat (lacosamide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Vimpat (lacosamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Vitrakvi® (larotrectinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2021

Vitrakvi® (larotrectinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Vizimpro® (dacomitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Vogelxo - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Vosevi®(sofosbuvir, velpatasvir, and voxilaprevir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Votrient® (pazopanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Vuity (pilocarpine) 1.25% ophthalmic solution - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.07.2022

Vumerity™ (diroximel fumarate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Vumerity™ (diroximel fumarate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Vyleesi (bremelanotide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Vyndamax (tafamidis) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Vyndamax (tafamidis) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Vyndaqel® (tafamidis meglumine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Vyndaqel® (tafamidis meglumine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Wakix® (pitolisant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Wakix® (pitolisant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Wegovy (semaglutide) - Prior Authorization – California, Maryland, New Mexico and New York Regulatory Program - Weight Loss - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Welireg™ (belzutifan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Winlevi (clascoterone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Xalkori® (crizotinib) - Prior Authorization/Non-Formulary - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Xalkori® (crizotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Xatmep (methotrexate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Xcopri (cenobamate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Xcopri (cenobamate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.13.2021

Xeljanz®/Xeljanz® XR/Xeljanz® Oral Solution (tofacitinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Xeljanz®/Xeljanz® XR/Xeljanz® Oral Solution (tofacitinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Xeljanz®/Xeljanz® XR/Xeljanz® Oral Solution (tofacitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Xenical (orlistat)- Prior Authorization – California, Maryland, New Mexico and New York Regulatory Program - Weight Loss - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Xermelo (telotristat ethyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Xifaxan (rifaximin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Xiidra® (lifitegrast 5% ophthalmic solution) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Xiidra® (lifitegrast 5% ophthalmic solution) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Xiidra™ (lifitegrast 5% ophthalmic solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.01.2021

Xiidra™ (lifitegrast 5% ophthalmic solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Ximino (minocycline extended-release capsule) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Xolair® (omalizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Xolair®(omalizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Xospata®(gilteritinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Xpovio™ (selinexor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Xtampza ER (oxycodone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Xtandi® (enzalutamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Xuriden® (uridine triacetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Xyntha (antihemophilic factor [recombinant]) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Xyosted - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Xyrem® (sodium oxybate) - Pior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Xyrem® (sodium oxybate) - Prior Authorization\Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Xywav (calcium, magnesium, potassium, and sodium oxybates) - Pior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Xywav (calcium, magnesium, potassium, and sodium oxybates) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2021

Xywav (calcium, magnesium, potassium, and sodium oxybates) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2021

Xywav (calcium, magnesium, potassium, and sodium oxybates) - Prior Authorization\Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Yonsa® (abiraterone acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Yupelri (revefenacin inhalation solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Zegerid for suspension (omeprazole and sodium bicarbonate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 01.21.2022

Zegerid for suspension (omeprazole and sodium bicarbonate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Zejula™ (niraparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Zelboraf™ (vemurafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Zelnorm (tegaserod) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Zelnorm (tegaserod) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Zepatier® (elbasvir/grazoprevir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Zepatier™ (elbasvir/grazoprevir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

Zepatier™ (elbasvir/grazoprevir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Zeposia® (ozanimod) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Zeposia® (ozanimod) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Zilxi (minocycline) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2021

Zilxi (minocycline) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2022

Zohydro ER (hydrocodone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2021

Zokinvy™ (lonafarnib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Zolinza® (vorinostat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Zomacton® - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Zomacton® - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Zonalon (doxepin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Zonegran - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2022

Zorbtive® - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 10.01.2021

Zorbtive® - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2022

Zovirax ointment (acyclovir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

ZTLido - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2021

Zydelig® (idelalisib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2022

Zykadia™ (ceritinib) - Non-Formulary - UnitedHealthcare Commercial Plans

Last Published 04.14.2022

Zykadia™ (ceritinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.20.2021

Zytiga® (abiraterone acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.02.2021

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Clinical Pharmacy Prior Authorization, Notification and Medical Necessity Requirements - Commercial