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 08.15.2022

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

Last Published 02.02.2023

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

Last Published 07.01.2022

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

Last Published 06.30.2023

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

Last Published 06.30.2023

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

Last Published 06.01.2023

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

Last Published 06.01.2023

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

Last Published 08.24.2023

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

Last Published 07.01.2022

Adalimumab - Abrilada (adalimumab-afzb), Adalimumab-adaz (unbranded Hyrimoz), Adalimumab-fkjp (unbranded Hulio)*, Amjevita™ (adalimumab-atto), Cyltezo® (adalimumab-adbm), Hadlima™ (adalimumab-bwwd), Hulio® (adalimumab-fkjp), Humira® (adalimumab), Hyrimoz® (adalimumab-adaz), Idacio (adalimumab-aacf), Yuflyma (adalimumab-aaty), and Yusimry (adalimumab-aqvh) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 07.19.2023

Adalimumab - Abrilada (adalimumab-afzb), Adalimumab-adaz (unbranded Hyrimoz), Adalimumab-fkjp (unbranded Hulio), Amjevita™ (adalimumab-atto), Cyltezo® (adalimumab-adbm), Hadlima™ (adalimumab-bwwd), Hulio® (adalimumab-fkjp)*, Humira® (adalimumab), Hyrimoz® (adalimumab-adaz), Idacio (adalimumab-aacf), Yuflyma (adalimumab-aaty), Yusimry (adalimumab-aqvh) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 07.19.2023

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

Last Published 06.01.2023

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

Last Published 06.01.2023

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

Last Published 12.01.2022

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

Last Published 12.01.2022

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

Last Published 08.01.2023

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

Last Published 04.17.2023

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

Last Published 12.01.2022

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

Last Published 06.01.2023

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

Last Published 07.01.2022

Aklief® (trifarotene) cream - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.24.2023

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

Last Published 08.24.2023

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

Last Published 01.27.2023

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

Last Published 11.01.2022

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

Last Published 02.07.2023

Altuviiio™ [antihemophilic factor (recombinant), Fc-VWF-XTEN fusion protein-ehtl] - Prior Authorization/Medical Necessity - UnitedHealth Commercial Plans

Last Published 06.30.2023

Altuviiio™ [antihemophilic factor (recombinant), Fc-VWF-XTEN fusion protein-ehtl] - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.30.2023

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

Last Published 12.01.2022

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

Last Published 02.01.2023

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

Last Published 08.01.2023

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

Last Published 08.24.2023

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

Last Published 03.01.2023

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

Last Published 12.15.2022

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

Last Published 02.01.2023

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

Last Published 07.01.2022

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

Last Published 08.01.2023

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

Last Published 04.17.2023

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

Last Published 02.01.2023

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

Last Published 07.01.2022

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

Last Published 06.30.2023

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

Last Published 06.30.2023

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

Last Published 07.01.2022

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

Last Published 12.01.2022

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

Last Published 08.01.2023

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

Last Published 12.15.2022

Banzel - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.28.2023

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

Last Published 11.01.2022

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

Last Published 07.01.2022

Benznidazole - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2023

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

Last Published 06.30.2023

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

Last Published 05.22.2023

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

Last Published 12.15.2022

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

Last Published 03.01.2023

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

Last Published 04.17.2023

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

Last Published 08.24.2023

Breast Cancer Prevention Zero Dollar Cost Share - generic tamoxifen (applies to 20 mg dose only), generic raloxifene, generic aromatase inhibitors (anastrozole, letrozole, or exemestane) - Prior Authorization - UnitedHealthcare Commercial Plans

Last Published 04.01.2023

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

Last Published 04.17.2023

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

Last Published 02.01.2023

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

Last Published 12.15.2022

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

Last Published 06.01.2023

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

Last Published 02.01.2023

Buprenorphine/Naloxone Products - Bunavail and Suboxone (Brand Only) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2023

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

Last Published 11.01.2022

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

Last Published 12.01.2022

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

Last Published 03.01.2023

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

Last Published 06.30.2023

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

Last Published 02.01.2023

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

Last Published 08.01.2023

Camzyos (mavacamten) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2023

Camzyos (mavacamten) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 05.22.2023

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

Last Published 08.15.2022

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

Last Published 06.01.2023

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

Last Published 02.01.2023

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

Last Published 05.22.2023

Cardiovascular Disease Prevention Prior Authorization - UnitedHealthcare Commercial Plans

Last Published 02.01.2023

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

Last Published 04.17.2023

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

Last Published 08.10.2022

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

Last Published 03.01.2023

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

Last Published 12.15.2022

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

Last Published 11.01.2022

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

Last Published 11.01.2022

CGRP Receptor Antagonists - Aimovig (erenumab), Ajovy (fremanezumab), Emgality (galcanezumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.01.2023

CGRP Receptor Antagonists - Aimovig (erenumab), Ajovy (fremanezumab), Emgality (galcanezumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.01.2023

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

Last Published 12.01.2022

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

Last Published 12.01.2022

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

Last Published 12.01.2022

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

Last Published 08.01.2023

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

Last Published 06.01.2023

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

Last Published 06.01.2023

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

Last Published 08.01.2023

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

Last Published 12.01.2022

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

Last Published 06.01.2023

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

Last Published 05.22.2023

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

Last Published 08.24.2023

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

Last Published 06.01.2023

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

Last Published 08.15.2022

Continuous glucose monitors, sensors and transmitters (all brands) - Prior Authrization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.17.2023

Contraceptive Medications - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2023

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

Last Published 08.01.2023

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

Last Published 12.15.2022

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

Last Published 04.01.2023

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

Last Published 06.30.2023

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

Last Published 04.17.2023

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

Last Published 02.01.2023

Cuvrior™ (trientine tetrahydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.12.2023

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

Last Published 02.02.2023

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

Last Published 02.01.2023

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

Last Published 08.01.2023

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

Last Published 04.01.2023

Daybue™ (trofinetide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.01.2023

Daybue™ (trofinetide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.01.2023

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

Last Published 03.01.2023

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 08.01.2023

Devices - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2022

Diabetes Medications – GLP-1 & Dual GIP/GLP-1 Receptor Agonists - Bydureon BCise (exenatide extended-release), Byetta (exenatide), Mounjaro (tirzepatide), Ozempic (semaglutide), Rybelsus (semaglutide), Trulicity (dulaglutide), Victoza (liraglutide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.01.2023

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 12.15.2022

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

Last Published 03.01.2023

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

Last Published 07.01.2022

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

Last Published 08.24.2023

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

Last Published 08.01.2023

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

Last Published 12.15.2022

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

Last Published 04.01.2023

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

Last Published 12.01.2022

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

Last Published 06.01.2023

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

Last Published 06.01.2023

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

Last Published 04.17.2023

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

Last Published 12.01.2022

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

Last Published 02.02.2023

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

Last Published 02.01.2023

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

Last Published 02.01.2023

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

Last Published 05.22.2023

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

Last Published 05.30.2023

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

Last Published 08.24.2023

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

Last Published 12.15.2022

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

Last Published 06.01.2023

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

Last Published 04.17.2023

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

Last Published 12.15.2022

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

Last Published 12.15.2022

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

Last Published 12.01.2022

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

Last Published 06.30.2023

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

Last Published 03.01.2023

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

Last Published 11.01.2022

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

Last Published 11.01.2022

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

Last Published 02.01.2023

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

Last Published 12.15.2022

Epsolay (benzoyl peroxide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2022

Ergomar (ergotamine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2023

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

Last Published 12.15.2022

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

Last Published 02.01.2023

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

Last Published 06.01.2023

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

Last Published 06.01.2023

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

Last Published 12.01.2022

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

Last Published 06.01.2023

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

Last Published 01.09.2023

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

Last Published 01.04.2023

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

Last Published 12.15.2022

Exforge HCT (amlodipine/valsartan/hydrochlorothiazide) - Prior Authorization/Non-Formulary - UnitedHealthcare Commercial Plans

Last Published 08.15.2022

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

Last Published 02.01.2023

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

Last Published 07.01.2022

Fasenra® (benralizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2023

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

Last Published 04.17.2023

Felbatol - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2023

Fentanyl - Actiq (fentanyl transmucosal lozenge), Fentora (fentanyl buccal tablet), Lazanda (fentanyl nasal spray), Subsys (fentanyl sublingual spray), and fentanyl citrate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.30.2023

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

Last Published 07.01.2022

Filspari™ (sparsentan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.30.2023

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

Last Published 02.01.2023

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

Last Published 12.15.2022

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

Last Published 06.30.2023

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

Last Published 06.30.2023

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

Last Published 02.01.2023

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

Last Published 12.15.2022

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

Last Published 11.01.2022

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

Last Published 04.17.2023

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

Last Published 08.01.2023

Furoscix® (furosemide injection) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2023

Furoscix® (furosemide injection) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2023

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

Last Published 08.01.2023

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

Last Published 02.01.2023

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

Last Published 12.15.2022

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

Last Published 12.15.2022

ganirelix acetate - Prior Authorizatin/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2022

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

Last Published 12.01.2022

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

Last Published 02.01.2023

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

Last Published 08.10.2022

Genotropin®- Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.10.2022

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

Last Published 08.24.2023

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

Last Published 12.15.2022

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

Last Published 04.17.2023

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

Last Published 02.02.2023

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

Last Published 11.01.2022

Gonococcal Ophthalmia Neonatorum (GON) Prevention Zero Dollar Cost Share – erythromycin 0.5% ophthalmic ointment - Prior Authorization/Regulatory - UnitedHealthcare Commercial Plans

Last Published 06.30.2023

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 06.01.2023

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

Last Published 06.01.2023

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 06.01.2023

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

Last Published 08.01.2023

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

Last Published 04.17.2023

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

Last Published 12.01.2022

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

Last Published 02.01.2023

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

Last Published 04.17.2023

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

Last Published 03.01.2023

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

Last Published 12.01.2022

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

Last Published 12.01.2022

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

Last Published 08.10.2022

Humatrope®- Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.10.2022

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

Last Published 02.01.2023

Hyftor™ (sirolimus topical gel) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2022

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

Last Published 04.17.2023

Ibsrela (tenapanor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2023

Ibsrela® (tenapanor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2023

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

Last Published 02.01.2023

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

Last Published 12.01.2022

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

Last Published 06.30.2023

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

Last Published 04.17.2023

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

Last Published 02.01.2023

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

Last Published 06.01.2023

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

Last Published 04.17.2023

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

Last Published 08.01.2023

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

Last Published 08.10.2022

Increlex® - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.10.2022

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 08.24.2023

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

Last Published 08.24.2023

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

Last Published 12.01.2022

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

Last Published 04.17.2023

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

Last Published 02.01.2023

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 08.24.2023

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 04.17.2023

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

Last Published 12.15.2022

Iron Chelators - Exjade® (deferasirox), Jadenu® (deferasirox), and Ferriprox® (deferiprone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.24.2023

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

Last Published 08.24.2023

Ivermectin - Prior Authorizatin/Notification - UnitedHealthcare Commerical Plans

Last Published 03.01.2023

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

Last Published 02.01.2023

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

Last Published 02.01.2023

Javygtor™ (sapropterin dihydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2023

Jaypirca® (pirtobrutinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2023

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

Last Published 12.01.2022

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

Last Published 04.17.2023

Joenja® (leniolisib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.01.2023

Joenja® (leniolisib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.01.2023

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

Last Published 07.01.2022

Juxtapid® (lomitapide) - Prior Authorization - Notification - UnitedHealthcare Commercial Plans

Last Published 04.17.2023

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

Last Published 10.01.2021

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

Last Published 11.01.2022

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

Last Published 08.24.2023

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

Last Published 08.24.2023

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

Last Published 03.01.2023

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

Last Published 03.01.2023

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

Last Published 03.01.2023

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

Last Published 07.01.2022

Keveyis® (dichlorphenamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.17.2023

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

Last Published 06.30.2023

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

Last Published 06.30.2023

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

Last Published 06.01.2023

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

Last Published 04.17.2023

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

Last Published 04.17.2023

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

Last Published 06.01.2023

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

Last Published 11.01.2022

Krazati™ (adagrasib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.17.2023

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

Last Published 06.01.2023

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

Last Published 04.17.2023

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

Last Published 04.17.2023

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

Last Published 03.01.2023

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

Last Published 03.01.2023

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

Last Published 02.01.2023

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

Last Published 07.01.2022

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

Last Published 04.17.2023

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

Last Published 08.01.2023

Levemir (insulin detemir) - Prior Authorizatin/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.24.2023

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

Last Published 12.01.2022

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

Last Published 02.01.2023

Lithobid - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2023

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

Last Published 08.02.2023

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

Last Published 08.31.2023

Livtencity (maribavir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.17.2023

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

Last Published 08.24.2023

Long-Acting Opioid Pain Medications - fentanyl transdermal patch (generic Duragesic) 12, 25, 50, 75, 100 mcg/hr, fentanyl transdermal patch 37.5, 62.5, 87.5 mcg/hr, hydrocodone extended-release capsules (generic Zohydro ER), hydrocodone extended-release tablets (generic Hysingla ER), hydromorphone extended-release (generic Exalgo), Hysingla ER, methadone, morphine sulfate controlled-release capsules (generic Avinza), morphine sulfate controlled-release tablets (generic MS Contin), morphine sulfate sustained-release capsules (generic Kadian), MS Contin, Nucynta ER (tapentadol extended-release), oxycodone controlled-release (authorized generic for OxyContin), OxyContin, oxymorphone extended-release (generic Opana ER), Xtampza ER (oxycodone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2023

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

Last Published 02.01.2023

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

Last Published 06.30.2023

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

Last Published 04.17.2023

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

Last Published 04.01.2023

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

Last Published 04.17.2023

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

Last Published 10.01.2021

Lupkynis (voclosporin) - Prior Authoization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 12.01.2022

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

Last Published 08.24.2023

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

Last Published 04.17.2023

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

Last Published 12.15.2022

Lyrica - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2023

Lytgobi® (futibatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2023

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

Last Published 04.01.2023

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

Last Published 11.01.2022

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

Last Published 11.01.2022

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

Last Published 08.01.2023

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

Last Published 11.01.2022

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

Last Published 12.15.2022

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

Last Published 08.24.2023

Methyldopa - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.24.2023

Mifeprex (mifepristone) - Benefit Determination - UnitedHealthcare Commercial Plans

Last Published 04.04.2023

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

Last Published 02.01.2023

Minocycline ER - minocycline extended-release tablet (generic Solodyn), Minolira (minocycline extended-release tablet ), Solodyn (minocycline extended-release tablet), Ximino (minocycline extended-release capsule) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.17.2023

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

Last Published 06.30.2023

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

Last Published 08.24.2023

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

Last Published 02.01.2023

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

Last Published 08.24.2023

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

Last Published 02.01.2023

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

Last Published 12.15.2022

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

Last Published 12.01.2022

Multiple Sclerosis - Aubagio® (teriflunomide), Avonex® (interferon β-1a), Bafiertam™ (monomethyl fumarate), Betaseron® (interferon β-1b), Copaxone® (glatiramer acetate), dimethyl fumarate, Extavia® (interferon β-1b), fingolimod, Gilenya® (fingolimod), Glatopa™ (glatiramer acetate), glatiramer acetate, Kesimpta (ofatumumab), Mayzent (siponimod)®, Plegridy™ (peginterferon β-1a), Ponvory™ (Ponesimod), Rebif® (interferon β-1a), Tascenso ODT™ (fingolimod), Tecfidera™ (dimethyl fumarate), teriflunomide, Vumerity™ (diroximel fumarate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.01.2023

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

Last Published 08.24.2023

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

Last Published 08.01.2023

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

Last Published 03.01.2023

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

Last Published 03.01.2023

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

Last Published 04.17.2023

Mysoline - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2023

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

Last Published 04.17.2023

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

Last Published 12.01.2022

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

Last Published 12.01.2022

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

Last Published 12.15.2022

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

Last Published 08.01.2023

Neurontin - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2023

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

Last Published 08.24.2023

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

Last Published 08.24.2023

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

Last Published 12.01.2022

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

Last Published 12.01.2022

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

Last Published 01.03.2023

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

Last Published 12.01.2022

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

Last Published 12.01.2022

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

Last Published 01.03.2023

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

Last Published 12.01.2022

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

Last Published 12.01.2022

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

Last Published 12.01.2022

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

Last Published 06.01.2023

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

Last Published 12.01.2022

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

Last Published 04.17.2023

Non-Solid Oral and Suppository Dosage Forms - Alkindi Sprinkle (hydrocortisone), Aspruzyo Sprinkle (ranolazine), Carafate (sucralfate) suspension, Carospir (spironolactone), chlorpromazine oral solution, Epaned (enalapril), Eprontia (topiramate), Ermeza (levothyroxine), Exservan (riluzole), Ezallor Sprinkle (rosuvastatin), Fleqsuvy (baclofen), Flolipid (simvastatin), Gloperba (colchicine), Indocin (indomethacin) suspension, Indocin (indomethacin) suppository, Katerzia (amlodipine), Lyvispah (baclofen), Meloxicam (meloxicam) suspension, Naprosyn (naproxen) suspension, Nexium for suspension (esomeprazole), Norliqva (amlodipine), Ozobax (baclofen), Pradaxa (dabigatran) oral pellets, Prevacid SoluTab (lansoprazole), Prograf Granules (tacrolimus), Qbrelis (lisinopril), Qdolo (tramadol), Renvela (sevelamer carbonate) powder for suspension, Sotylize (sotalol), Syndros (dronabinol), Tiglutik (riluzole), Tirosint-Sol (levothyroxine), Valsartan oral solution, Xatmep (methotrexate), Zegerid for suspension (omeprazole and sodium bicarbonate), Zonisade (zonisamide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.02.2023

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

Last Published 08.10.2022

NordiFlex®- Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.10.2022

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

Last Published 08.10.2022

Norditropin® - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.10.2022

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

Last Published 06.30.2023

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

Last Published 03.01.2023

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

Last Published 02.01.2023

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

Last Published 12.01.2022

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

Last Published 08.24.2023

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

Last Published 02.01.2023

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) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 03.01.2023

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

Last Published 06.01.2023

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

Last Published 06.01.2023

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

Last Published 08.10.2022

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

Last Published 08.10.2022

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

Last Published 08.24.2023

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

Last Published 08.24.2023

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

Last Published 06.01.2023

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

Last Published 06.01.2023

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

Last Published 12.15.2022

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

Last Published 06.01.2023

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

Last Published 06.01.2023

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

Last Published 11.01.2022

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

Last Published 11.01.2022

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

Last Published 12.01.2022

Omnipod 5 - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.28.2023

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

Last Published 08.10.2022

Omnitrope®- Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.10.2022

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

Last Published 12.15.2022

Onfi - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2023

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

Last Published 03.01.2023

Opioid Supply Limits - Greater than 34 Day Supply for Opioids at Retail

Last Published 08.04.2023

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

Last Published 06.01.2023

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

Last Published 12.01.2022

Oral chemotherapeutic agents - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.01.2022

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

Last Published 06.01.2023

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

Last Published 06.01.2023

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

Last Published 06.30.2023

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

Last Published 11.01.2022

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

Last Published 08.01.2023

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

Last Published 04.17.2023

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

Last Published 04.17.2023

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

Last Published 04.17.2023

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

Last Published 08.24.2023

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

Last Published 08.24.2023

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

Last Published 12.15.2022

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

Last Published 06.01.2023

Orserdu™ (elacestrant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2023

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

Last Published 06.01.2023

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

Last Published 04.17.2023

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

Last Published 02.01.2023

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

Last Published 04.17.2023

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

Last Published 04.17.2023

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

Last Published 04.17.2023

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

Last Published 04.17.2023

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

Last Published 06.01.2023

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

Last Published 06.01.2023

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

Last Published 08.09.2023

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

Last Published 08.09.2023

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 12.15.2022

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

Last Published 08.01.2023

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

Last Published 11.01.2022

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

Last Published 08.01.2023

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

Last Published 08.24.2023

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

Last Published 08.24.2023

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

Last Published 02.01.2023

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

Last Published 08.24.2023

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

Last Published 08.24.2023

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

Last Published 04.01.2023

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

Last Published 06.01.2023

Pulmonary arterial hypertension (PAH) - Adcirca® (tadalafil), Adempas® (riociguat), Alyq™ (tadalafil), Letairis® (ambrisentan), Opsumit® (macitentan), Orenitram™ (treprostinil), Revatio® oral powder for suspension (sildenafil citrate), Tadliq® (tadalafil) oral suspension, Tracleer® (bosentan), Tyvaso® (treprostinil), Tyvaso DPI™ (treprostinil), Uptravi® (selexipag), Ventavis® (iloprost) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.09.2023

Pulmonary arterial hypertension (PAH) - Adcirca® (tadalafil), Adempas® (riociguat), Alyq™ (tadalafil), Letairis® (ambrisentan), Opsumit® (macitentan), Orenitram™ (treprostinil), Revatio® Suspension (sildenafil citrate), Tracleer® (bosentan), Tyvaso® (treprostinil), Tyvaso DPI™ (treprostinil), Uptravi® (selexipag), Ventavis® (iloprost) - Prior Authorizatin/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2023

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

Last Published 04.17.2023

Pyrukynd® (mitapivat) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.01.2023

Pyrukynd® (mitapivat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.01.2023

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

Last Published 03.08.2023

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

Last Published 10.01.2021

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

Last Published 06.01.2023

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

Last Published 06.01.2023

Radicava ORS® (edaravone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.11.2022

Radicava ORS® (edaravone)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.11.2022

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

Last Published 06.01.2023

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

Last Published 06.01.2023

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

Last Published 04.17.2023

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

Last Published 04.17.2023

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

Last Published 04.17.2023

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

Last Published 02.01.2023

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

Last Published 10.01.2021

Relyvrio™ (sodium phenylbutyrate and taurursodiol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2023

Relyvrio™ (sodium phenylbutyrate and taurursodiol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.01.2023

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

Last Published 08.24.2023

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

Last Published 08.24.2023

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

Last Published 08.10.2022

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

Last Published 03.01.2023

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

Last Published 02.01.2023

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

Last Published 07.01.2022

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

Last Published 08.01.2023

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

Last Published 10.01.2021

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

Last Published 06.01.2023

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

Last Published 06.01.2023

Rezlidhia™ (olutasidenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.17.2023

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

Last Published 12.01.2022

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

Last Published 06.30.2023

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

Last Published 08.24.2023

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

Last Published 08.24.2023

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

Last Published 04.01.2023

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

Last Published 06.30.2023

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

Last Published 06.30.2023

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 03.01.2023

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

Last Published 10.01.2021

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

Last Published 08.24.2023

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

Last Published 12.15.2022

Sabril - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2023

Saizen® - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.10.2022

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

Last Published 08.10.2022

Sajazir™ (icatibant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.30.2023

Sajazir™ (icatibant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.30.2023

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

Last Published 08.24.2023

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

Last Published 04.01.2023

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

Last Published 03.01.2023

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

Last Published 04.01.2023

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

Last Published 11.01.2022

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

Last Published 08.10.2022

Serostim®- Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.10.2022

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

Last Published 12.15.2022

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

Last Published 06.30.2023

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

Last Published 04.17.2023

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

Last Published 08.01.2023

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

Last Published 03.01.2023

Skyclarys™ (omaveloxolone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.01.2023

Skyclarys™ (omaveloxolone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.01.2023

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

Last Published 11.01.2022

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

Last Published 11.01.2022

Skytrofa™ (lonapegsomatropin-tcgd) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.10.2022

Skytrofa™ (lonapegsomatropin-tcgd) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.10.2022

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

Last Published 04.17.2023

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

Last Published 03.01.2023

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

Last Published 10.01.2021

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

Last Published 03.04.2023

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

Last Published 03.04.2023

Sotyktu™ (deucravacitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.01.2023

Sotyktu™ (deucravacitinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.30.2023

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

Last Published 08.01.2023

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

Last Published 08.01.2023

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

Last Published 03.01.2023

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

Last Published 03.01.2023

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

Last Published 12.15.2022

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

Last Published 06.01.2023

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

Last Published 12.01.2022

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

Last Published 08.24.2023

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

Last Published 08.24.2023

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

Last Published 02.01.2023

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

Last Published 04.14.2022

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

Last Published 07.01.2022

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

Last Published 04.01.2023

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

Last Published 04.01.2023

Sunlenca® (lenacapavir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2023

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

Last Published 12.01.2022

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

Last Published 12.01.2022

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

Last Published 06.01.2023

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

Last Published 08.24.2023

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

Last Published 08.24.2023

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

Last Published 12.15.2022

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

Last Published 02.01.2023

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

Last Published 02.01.2023

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

Last Published 08.24.2023

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

Last Published 10.01.2021

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

Last Published 08.01.2023

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

Last Published 02.01.2023

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

Last Published 06.01.2023

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

Last Published 06.01.2023

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

Last Published 06.30.2023

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

Last Published 01.27.2023

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

Last Published 03.01.2023

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

Last Published 02.01.2023

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

Last Published 07.01.2022

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

Last Published 02.01.2023

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

Last Published 06.01.2023

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

Last Published 04.01.2023

Tavneos® (avacopan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 05.02.2023

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

Last Published 04.01.2023

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

Last Published 08.01.2023

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

Last Published 07.01.2022

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

Last Published 06.01.2023

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

Last Published 02.01.2023

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

Last Published 02.01.2023

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

Last Published 02.01.2023

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

Last Published 06.30.2023

Testosterone - Androderm, Androgel, Fortesta, Jatenzo, Natesto, Kyzatrex, Testim, testosterone topical solution (generic Axiron), testosterone transdermal gel (generic Testim), Tlando, Vogelxo, Xyosted - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.01.2023

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

Last Published 04.17.2023

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

Last Published 08.01.2023

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

Last Published 02.01.2023

Tobramycin Inhalation - Bethkis®, Kitabis® Pak, TOBI™ Nebulizer Solution and TOBI® Podhaler™, tobramycin solution for inhalation - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.17.2023

Topamax - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2023

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

Last Published 03.01.2023

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

Last Published 12.01.2022

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

Last Published 06.01.2023

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

Last Published 08.24.2023

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

Last Published 08.24.2023

Trileptal - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2023

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

Last Published 02.01.2023

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

Last Published 02.01.2023

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

Last Published 02.01.2023

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

Last Published 10.01.2021

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

Last Published 06.01.2023

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

Last Published 12.15.2022

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

Last Published 02.01.2023

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

Last Published 04.17.2023

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

Last Published 08.10.2022

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

Last Published 03.01.2023

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

Last Published 06.01.2023

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

Last Published 06.01.2023

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

Last Published 03.01.2023

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

Last Published 12.15.2022

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

Last Published 12.15.2022

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

Last Published 06.01.2023

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

Last Published 06.01.2023

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

Last Published 12.01.2022

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

Last Published 08.24.2023

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

Last Published 12.15.2022

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

Last Published 06.30.2023

Verkazia (cyclosporine 0.1% ophthalmic emulsion) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.01.2023

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

Last Published 03.01.2023

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

Last Published 12.01.2022

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

Last Published 08.01.2023

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

Last Published 06.01.2023

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

Last Published 04.17.2023

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

Last Published 08.01.2023

Vijoice® (alpelisib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 08.24.2023

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

Last Published 08.24.2023

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

Last Published 12.15.2022

Vimpat - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2023

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

Last Published 04.01.2023

Vivjoa (oteseconazole) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2022

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

Last Published 02.01.2023

Vonjo (pacritinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.01.2022

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

Last Published 02.02.2023

Vosevi™ (sofosbuvir, velpatasvir, and voxilaprevir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 11.01.2022

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

Last Published 02.01.2023

Voxzogo™ (vosoritide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 06.01.2023

Voxzogo™ (vosoritide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 06.01.2023

Vtama® (tapinarof) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.07.2023

Vtama® (tapinarof) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 02.07.2023

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

Last Published 06.01.2023

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

Last Published 08.01.2023

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

Last Published 12.01.2022

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

Last Published 04.17.2023

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

Last Published 04.17.2023

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

Last Published 04.17.2023

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

Last Published 04.17.2023

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

Last Published 06.01.2023

Weight Loss – phentermine (all brand products including Adipex-P and Lomaira), benzphetamine, Contrave (naltrexone HCl and bupropion HCl, diethylpropion, Imcivree (setmelanotide), phendimetrazine, orlistat (Xenical), Qsymia (phentermine and topiramate extended-release), Saxenda (liraglutide), and Wegovy (semaglutide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 04.17.2023

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

Last Published 12.15.2022

Xalkori® (crizotinib) - Non-Formulary - UnitedHealthcare Commercial Plans

Last Published 06.30.2023

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

Last Published 04.17.2023

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

Last Published 02.01.2023

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

Last Published 12.15.2022

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

Last Published 12.01.2022

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

Last Published 04.17.2023

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

Last Published 08.24.2023

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

Last Published 10.27.2022

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

Last Published 03.01.2023

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

Last Published 02.01.2023

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

Last Published 11.01.2022

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

Last Published 04.17.2023

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

Last Published 04.01.2023

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

Last Published 06.01.2023

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

Last Published 08.24.2023

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

Last Published 12.01.2022

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

Last Published 02.01.2023

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

Last Published 02.01.2023

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

Last Published 02.02.2023

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

Last Published 02.02.2023

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

Last Published 04.17.2023

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

Last Published 02.01.2023

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

Last Published 08.24.2023

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

Last Published 06.01.2023

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

Last Published 04.17.2023

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

Last Published 04.17.2023

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

Last Published 06.30.2023

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

Last Published 03.01.2023

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

Last Published 03.01.2023

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

Last Published 06.01.2023

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

Last Published 12.15.2022

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

Last Published 08.10.2022

Zomacton® - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.10.2022

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

Last Published 06.01.2023

Zonegran - Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 03.01.2023

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

Last Published 08.10.2022

Zorbtive® - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 08.10.2022

Zoryve™ (roflumilast) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 04.25.2023

Zoryve™ (roflumilast) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 01.04.2023

Ztalmy (ganaxolone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Published 02.01.2023

Ztalmy (ganaxolone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.15.2022

ZTLido - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Published 12.01.2022

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

Last Published 08.01.2023

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

Last Published 04.17.2023

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

Last Published 06.30.2023

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

Last Published 08.01.2023

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