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

Absorica (isotretinoin) Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 10.01.2018

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

Last Modified 08.13.2018

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

Last Modified 10.01.2018

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

Last Modified 10.01.2018

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

Last Modified 11.30.2018

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

Last Modified 08.13.2018

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

Last Modified 08.31.2018

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

Last Modified 08.13.2018

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

Last Modified 08.13.2018

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

Last Modified 08.15.2018

Adcirca (tadalafil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plan

Last Modified 08.15.2018

Adderall (amphetamine-dextroamphetamine mixed salts) and Adderall XR (amphetamine-dextroamphetamine mixed salts, extended release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.28.2018

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

Last Modified 08.15.2018

Addyi (flibanserin) Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.15.2018

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

Last Modified 08.15.2018

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

Last Modified 08.15.2018

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

Last Modified 12.11.2018

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

Last Modified 08.15.2018

Adzenys XR-ODT (amphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.28.2018

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

Last Modified 08.15.2018

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

Last Modified 12.11.2018

Afstyla [Antihemophilic Factor (Recombinant), single chain] - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.15.2018

Afstyla [Antihemophilic Factor (Recombinant), single chain] - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.15.2018

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

Last Modified 01.15.2019

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

Last Modified 12.27.2018

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

Last Modified 01.15.2019

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

Last Modified 12.27.2018

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

Last Modified 08.31.2018

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

Last Modified 10.31.2018

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

Last Modified 08.31.2018

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

Last Modified 12.12.2018

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

Last Modified 12.11.2018

Amnesteem (isotretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 10.01.2018

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

Last Modified 12.10.2018

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

Last Modified 08.31.2018

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

Last Modified 08.31.2018

Aptensio XR (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.28.2018

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

Last Modified 12.11.2018

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

Last Modified 11.30.2018

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

Last Modified 08.15.2018

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

Last Modified 08.15.2018

Atralin (retinoic) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.15.2018

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

Last Modified 12.10.2018

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

Last Modified 08.15.2018

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

Last Modified 08.15.2018

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

Last Modified 08.15.2018

Avita (retinoic) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.15.2018

Avonex (teriflunomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 12.10.2018

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

Last Modified 08.31.2018

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

Last Modified 12.11.2018

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

Last Modified 08.16.2018

Belviq - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 12.27.2018

Belviq XR (lorcaserin extended-release) - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.28.2018

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

Last Modified 11.28.2018

Benznidazole - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

Benzphetamine - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 12.27.2018

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

Last Modified 10.01.2018

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

Last Modified 12.11.2018

Bethkis (tobramycin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

Bonjesta - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 10.01.2018

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

Last Modified 08.20.2018

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

Last Modified 10.31.2018

Bravelle (urofollitropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.21.2018

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

Last Modified 11.30.2018

Briviact Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 12.11.2018

Bunavail/Buprenorphine/Naloxone/Suboxone (buprenorphine/naloxone products) – Prior Authorization/Medical Necessity – Oxford

Last Modified 11.30.2018

Bunavail/Buprenorphine/Naloxone/Suboxone (buprenorphine/naloxone products) – Prior Authorization/Notification – UnitedHealthcare Commercial Plans

Last Modified 11.29.2018

Bupropion SR (generic Zyban) - Prior Authorization - UnitedHealthcare Commercial Plans

Last Modified 12.19.2018

Bupropion SR - Tobacco Cessation (Applies to KY Fully Insured) - Supply Limit Override - UnitedHealthcare Commercial Plans

Last Modified 01.08.2019

Bupropion SR -Tobacco Cessation (Applies to NJ Fully Insured) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 12.19.2018

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

Last Modified 08.20.2018

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

Last Modified 08.31.2018

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

Last Modified 12.11.2018

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

Last Modified 10.01.2018

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

Last Modified 10.01.2018

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

Last Modified 08.20.2018

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

Last Modified 08.20.2018

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

Last Modified 11.28.2018

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

Last Modified 08.17.2018

Chantix (varenicline) - Prior Authorization - UnitedHealthcare Commercial Plans

Last Modified 12.19.2018

Chantix / Tobacco Cessation (applies to NJ Fully Insured) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 12.12.2018

Chantix/Tobacco Cessation (applies to KY Fully Insured) - Supply Limit Override - UnitedHealthcare Commercial Plans

Last Modified 01.08.2019

Cholbam (varenicline) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.28.2018

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

Last Modified 10.31.2018

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

Last Modified 10.01.2018

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

Last Modified 10.01.2018

Claravis (isotretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 10.01.2018

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

Last Modified 08.21.2018

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

Last Modified 08.31.2018

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

Last Modified 08.31.2018

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

Last Modified 08.20.2018

Concerta (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.28.2018

Continuous Glucose Monitoring - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

Continuous Glucose Monitoring - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

Contrave (naltrexone and bupropion) - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 12.27.2018

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

Last Modified 12.11.2018

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

Last Modified 08.20.2018

Cosentyx (secukinumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.21.2018

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

Last Modified 08.20.2018

Cotempla XR-ODT (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.28.2018

Crinone (progesterone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

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

Last Modified 08.31.2018

Daklinza (daclatasvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

Daklinza (daclatasvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.28.2018

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

Last Modified 08.20.2018

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

Last Modified 08.21.2018

Daytrana (methyphenidate transdermal) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.28.2018

Depakote and Depakote ER (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 12.12.2018

Depo-Provera (medroxyprogesterone acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

Desoxyn (methamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.28.2018

Dexedrine (dextroamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.28.2018

Dextrostat (CNS Stimulants) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

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

Last Modified 08.31.2018

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

Last Modified 10.01.2018

Diethylpropion - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.28.2018

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

Last Modified 08.20.2018

Dolophine Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.21.2018

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

Last Modified 10.31.2018

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

Last Modified 11.30.2018

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

Last Modified 10.01.2018

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

Last Modified 08.21.2018

Duragesic Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.21.2018

Duzallo (lesinurad/allopurinol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

Dyanavel XR (amphetamine extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.28.2018

Egrifta (tesamorelin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.21.2018

Elidel (pimecrolimus) Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.16.2018

Eligard (leuprolide acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 10.01.2018

Eloctate (Antihemophilic Factor Recombinant, Fc Fusion Protein) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

Eloctate (antihemophilic factor recomninant, Fc fusion protein) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

Embeda (morphine sulfate and naltrexone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

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

Last Modified 08.17.2018

Emflaza (deflazacort) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

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

Last Modified 01.15.2019

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

Last Modified 12.27.2018

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

Last Modified 08.31.2018

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

Last Modified 08.21.2018

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

Last Modified 08.20.2018

Endometrin (progesterone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

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

Last Modified 12.12.2018

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

Last Modified 12.11.2018

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

Last Modified 08.20.2018

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

Last Modified 08.20.2018

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

Last Modified 10.31.2018

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

Last Modified 08.21.2018

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

Last Modified 11.28.2018

ErleadaTM (apalutamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.21.2018

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

Last Modified 11.30.2018

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

Last Modified 11.28.2018

Evekeo (amphetamine sulfate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.28.2018

Evista (raloxifene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

Evzio (naloxone hydrochloride) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

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

Last Modified 08.21.2018

Exforge - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.21.2018

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

Last Modified 11.28.2018

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

Last Modified 12.11.2018

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

Last Modified 08.21.2018

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

Last Modified 08.21.2018

Felbatol (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 12.12.2018

Fentanyl (opioid analgesics) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.21.2018

Fentanyl citrate powder PA/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

Fentanyl Transdermal Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.21.2018

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

Last Modified 08.20.2018

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

Last Modified 08.21.2018

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

Last Modified 11.28.2018

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

Last Modified 10.01.2018

FIRST Progesterone VGS (progesterone vaginal suppository compounding kit) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.21.2018

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

Last Modified 08.20.2018

Focalin (dexmethylphenidate) and Focalin XR (dexmethylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.28.2018

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

Last Modified 08.21.2018

Follistim AQ Medical Necessity – Supported by Fertility Solutions - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 09.17.2018

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

Last Modified 10.31.2018

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

Last Modified 08.20.2018

Fortesta (topical andogens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.31.2018

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

Last Modified 11.30.2018

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

Last Modified 12.11.2018

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

Last Modified 12.27.2018

Ganirelix Acetate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

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

Last Modified 11.28.2018

Genotropin (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

Genotropin (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

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

Last Modified 12.11.2018

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

Last Modified 08.31.2018

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

Last Modified 12.11.2018

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

Last Modified 11.28.2018

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

Last Modified 10.31.2018

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

Last Modified 10.31.2018

Gonal f/Gonal f RFF Medical Necessity – Supported by Fertility Solutions - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 09.17.2018

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

Last Modified 08.21.2018

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

Last Modified 08.21.2018

Grastek (sublingual immunotherapy) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.16.2018

Grastek (sublingual Immunotherapy) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.15.2018

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

Last Modified 10.01.2018

Haegarda - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 10.01.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

Health Care Reform Breast Cancer Prevention Copay Reduction (tamoxifen/soltamax/evista) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

Helixate (antihemophilic factor recombinant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

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

Last Modified 12.11.2018

Hemlibra - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 12.27.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

Humatrope (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

Humatrope (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

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

Last Modified 10.31.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

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

Last Modified 11.29.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

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

Last Modified 11.29.2018

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

Last Modified 08.17.2018

Increlex (mecasermin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

Increlex (mecasermin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

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

Last Modified 10.31.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

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

Last Modified 10.01.2018

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

Last Modified 10.31.2018

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

Last Modified 08.17.2018

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

Last Modified 11.29.2018

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

Last Modified 08.17.2018

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

Last Modified 11.29.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

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

Last Modified 11.30.2018

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

Last Modified 08.17.2018

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

Last Modified 10.31.2018

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

Last Modified 08.17.2018

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

Last Modified 10.31.2018

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

Last Modified 10.31.2018

Keppra and Keppra XR (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 12.12.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

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

Last Modified 10.01.2018

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

Last Modified 08.17.2018

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

Last Modified 11.29.2018

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

Last Modified 12.27.2018

Kitabis Pak (tobramycin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

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

Last Modified 08.17.2018

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

Last Modified 12.11.2018

Kynamro (mipomersen sodium) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 11.30.2018

Kynamro (mipomersen sodium) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

Lamictal and Lamictal XR (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 12.12.2018

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

Last Modified 12.19.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

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

Last Modified 10.01.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

Leuprolide Acetate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 10.01.2018

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

Last Modified 08.20.2018

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

Last Modified 12.11.2018

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

Last Modified 12.27.2018

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

Last Modified 11.29.2018

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

Last Modified 08.17.2018

Lovaza (omega-3-acid ethyl esters) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 10.01.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

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

Last Modified 08.20.2018

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

Last Modified 10.31.2018

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

Last Modified 08.17.2018

Menopur (Supported by Fertility Solutions) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 10.31.2018

Metadate (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.29.2018

Metadate CD (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.29.2018

Methylin and Methylin ER (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.29.2018

Migranal Nasal Spray (dihydroergotamine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

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

Last Modified 08.20.2018

Morphine Sulfate (generic MS Contin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

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

Last Modified 12.27.2018

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

Last Modified 12.11.2018

MS Contin (long-acting opioid analgesic) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

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

Last Modified 12.27.2018

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

Last Modified 08.31.2018

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

Last Modified 12.12.2018

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

Last Modified 12.11.2018

Mydayis (dextroamphetamine-amphetamine mixed salts) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.29.2018

Myorisan (isotretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 10.01.2018

Mysoline (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 12.12.2018

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

Last Modified 08.17.2018

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

Last Modified 08.31.2018

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

Last Modified 11.30.2018

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

Last Modified 11.29.2018

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

Last Modified 11.29.2018

Neurontin (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 12.12.2018

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

Last Modified 10.01.2018

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

Last Modified 08.17.2018

Nicotine Gum / Lozenge / Patch - Prior Authorization - UnitedHealthcare Commercial Plans

Last Modified 12.19.2018

Nicotine Gum/Lozenge/Patch - Tobacco Cessation (Applies to KY Fully Insured) - Supply Limit Override - UnitedHealthcare Commercial Plans

Last Modified 01.08.2019

Nicotine Gum/Lozenge/Patch - Tobacco Cessation (Applies to NJ Fully Insured) - UnitedHealthcare Commercial Plans

Last Modified 01.08.2019

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

Last Modified 12.19.2018

Nicotrol Inhaler - Tobacco Cessation (Applies to KY Fully Insured) - Supply Limit Override - UnitedHealthcare Commercial Plans

Last Modified 01.08.2019

Nicotrol Inhaler - Tobacco Cessation (Applies to NJ Fully Insured) - nitedHealthcare Commercial Plans

Last Modified 01.08.2019

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

Last Modified 12.19.2018

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

Last Modified 01.08.2019

Nicotrol NS - Toibacco Cessation (Applies to NJ Fully Insured) - UnitedHealthcare Commercial Plans

Last Modified 01.08.2019

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

Last Modified 08.20.2018

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

Last Modified 11.29.2018

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

Last Modified 10.01.2018

Non-Formulary Copay Adjustment Notification (applies to New Jersey) - Prior Authorization/Regulatory - UnitedHealthcare Commercial Plans

Last Modified 10.31.2018

NordiFlex (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

NordiFlex (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

Norditropin (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

Norditropin (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 10.31.2018

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

Last Modified 08.20.2018

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

Last Modified 08.20.2018

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

Last Modified 08.20.2018

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

Last Modified 08.17.2018

Nuplazid (pimavanserin tartrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 12.11.2018

Nutropin and Nutropin AQ (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

Nutropin AQ (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

Nutropin AQ NuSpin (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

Nutropin AQ NuSpin (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.26.2018

NuvaRing (etonogestrel / ethinyl estradiol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

Nuvigil (armodafinil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

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

Last Modified 08.31.2018

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

Last Modified 08.31.2018

Odactra (sublingual immunotherapy) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

Odactra (sublingual immunotherapy) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

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

Last Modified 11.29.2018

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

Last Modified 11.30.2018

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

Last Modified 11.29.2018

Olumiant - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 10.01.2018

Olysio (simeprevir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

Olysio (simeprevir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

Omnitrope (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

Omnitrope (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

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

Last Modified 12.12.2018

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

Last Modified 08.20.2018

Opioid Containing Cough & Cold Medicines - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 10.31.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

Oralair (sublingual immunotherapy) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

Oralair (sublingual immunotherapy) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.20.2018

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

Last Modified 10.31.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

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

Last Modified 08.20.2018

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

Last Modified 12.27.2018

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

Last Modified 10.31.2018

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

Last Modified 11.29.2018

OrthoEvra (norelgestromin-ethinyl estradiol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

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

Last Modified 08.20.2018

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

Last Modified 08.20.2018

Oxistat (oxiconazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 11.30.2018

Oxtellar (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 12.12.2018

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

Last Modified 08.20.2018

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

Last Modified 12.27.2018

Palynziq - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 10.01.2018

PEG-Intron (peginterferon alfa-2b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

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

Last Modified 08.17.2018

Phendimetrazine - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 12.27.2018

Phentermine - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 12.10.2018

Plegridy (peginterferon)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 12.11.2018

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

Last Modified 08.20.2018

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

Last Modified 08.17.2018

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

Last Modified 10.01.2018

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

Last Modified 08.20.2018

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

Last Modified 08.17.2018

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

Last Modified 08.31.2018

Procentra (dextroamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.29.2018

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

Last Modified 08.31.2018

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

Last Modified 08.17.2018

Provigil (modafanil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.17.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

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

Last Modified 08.17.2018

Qsymia (phentermine, topiramate extended-release) - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.29.2018

Qudexy XR (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 12.19.2018

QuilliChew ER (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.29.2018

Quillivant XR (methylphenidate extendedrelease) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.29.2018

Ragwitek (sublingual immunotherapy) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.09.2018

Ragwitek (sublingual immunotherapy) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.09.2018

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

Last Modified 12.12.2018

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

Last Modified 12.12.2018

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

Last Modified 12.11.2018

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

Last Modified 08.09.2018

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

Last Modified 10.31.2018

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

Last Modified 12.12.2018

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

Last Modified 08.10.2018

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

Last Modified 08.10.2018

Restasis (cyclosporine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 12.12.2018

Restasis (cyclosporine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 12.11.2018

Retin-A (tretinoin) / Retin-A Micro (tretinoin microspheres) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.13.2018

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

Last Modified 08.10.2018

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

Last Modified 08.10.2018

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

Last Modified 08.10.2018

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

Last Modified 08.10.2018

Rhofade (oxymetazoline) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 12.12.2018

Ritalin (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.29.2018

Ritalin LA (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.29.2018

Ritalin SR (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.29.2018

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

Last Modified 11.29.2018

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

Last Modified 10.01.2018

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

Last Modified 08.31.2018

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

Last Modified 12.12.2018

Saizen (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.10.2018

Saizen (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.10.2018

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

Last Modified 11.29.2018

Saxenda (liraglutide) - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 12.27.2018

Select Excluded Medications - Prior Authorization (Applies to Connecticut, New Jersey, New York) - Commercial

Last Modified 10.17.2018

Select Excluded Medications - Prior Authorization (Does NOT apply to Connecticut, New Jersey, New York) - Commercial

Last Modified 10.17.2018

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

Last Modified 12.11.2018

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

Last Modified 12.12.2018

Serostim (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.10.2018

Serostim (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.10.2018

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

Last Modified 11.29.2018

Sildenafil Citrate (generic Revatio) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.10.2018

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

Last Modified 08.10.2018

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

Last Modified 08.13.2018

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

Last Modified 08.13.2018

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

Last Modified 12.11.2018

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

Last Modified 10.01.2018

Soliqua (insulin glargine/lixisenatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 12.12.2018

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

Last Modified 08.13.2018

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

Last Modified 08.13.2018

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

Last Modified 10.01.2018

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

Last Modified 10.01.2018

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

Last Modified 08.13.2018

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

Last Modified 08.13.2018

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

Last Modified 08.13.2018

Spritam (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 12.12.2018

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

Last Modified 08.13.2018

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

Last Modified 08.13.2018

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

Last Modified 08.13.2018

Stendra Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.13.2018

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

Last Modified 08.31.2018

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

Last Modified 08.13.2018

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

Last Modified 08.13.2018

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

Last Modified 08.31.2018

Suboxone Film (buprenorphine HCL-naloxone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.13.2018

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

Last Modified 08.13.2018

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

Last Modified 08.13.2018

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

Last Modified 08.13.2018

Sylatron (peginterferon alfa-2b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.13.2018

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

Last Modified 08.13.2018

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

Last Modified 08.13.2018

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

Last Modified 12.11.2018

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

Last Modified 08.13.2018

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

Last Modified 10.31.2018

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

Last Modified 08.31.2018

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

Last Modified 08.13.2018

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

Last Modified 08.13.2018

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

Last Modified 08.13.2018

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

Last Modified 08.13.2018

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

Last Modified 08.13.2018

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

Last Modified 08.13.2018

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

Last Modified 10.31.2018

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

Last Modified 08.13.2018

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

Last Modified 12.11.2018

Technivie (ombitasvir, paritaprevir, ritonavir tablets) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.13.2018

Technivie (ombitasvir, paritaprevir, ritonavir tablets) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.13.2018

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

Last Modified 11.29.2018

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

Last Modified 08.31.2018

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

Last Modified 08.13.2018

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

Last Modified 08.13.2018

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

Last Modified 12.27.2018

TOBI (tobramycin inhalation solution-powder) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.13.2018

Topamax (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 12.12.2018

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

Last Modified 08.10.2018

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

Last Modified 08.10.2018

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

Last Modified 11.29.2018

Tretin-X (tretinoin-cleanser) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.10.2018

Trileptal (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 12.12.2018

Trintellix (vortioxetine) - Prior Authorization - UnitedHealthcare Commercial Plans

Last Modified 08.10.2018

Trokendi XR (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 12.12.2018

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

Last Modified 12.11.2018

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

Last Modified 08.10.2018

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

Last Modified 11.29.2018

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

Last Modified 08.10.2018

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

Last Modified 08.10.2018

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

Last Modified 08.10.2018

Ultravate Lotion (halobetasol propionate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.10.2018

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

Last Modified 08.10.2018

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

Last Modified 08.10.2018

Valchlor (mechlorethamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.29.2018

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

Last Modified 08.10.2018

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

Last Modified 10.01.2018

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

Last Modified 08.10.2018

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

Last Modified 10.31.2018

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

Last Modified 08.10.2018

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

Last Modified 08.10.2018

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

Last Modified 08.10.2018

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

Last Modified 08.31.2018

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

Last Modified 08.10.2018

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

Last Modified 12.12.2018

Viekira Pak & Viekira Pak XR (ombitasvir, paritaprevir, ritonavir, dasabuvir tablets) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.10.2018

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

Last Modified 08.10.2018

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

Last Modified 11.30.2018

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

Last Modified 12.12.2018

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

Last Modified 08.31.2018

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

Last Modified 08.10.2018

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

Last Modified 08.10.2018

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

Last Modified 08.10.2018

Vyvanse (lisdexamfetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.29.2018

Xadago (safinamide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.10.2018

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

Last Modified 08.10.2018

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

Last Modified 08.10.2018

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

Last Modified 10.31.2018

Xenical (orlistat) - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 12.27.2018

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

Last Modified 08.31.2018

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

Last Modified 08.10.2018

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

Last Modified 12.12.2018

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

Last Modified 12.11.2018

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

Last Modified 08.09.2018

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

Last Modified 08.10.2018

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

Last Modified 10.31.2018

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

Last Modified 08.31.2018

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

Last Modified 08.10.2018

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

Last Modified 10.01.2018

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

Last Modified 10.01.2018

Zegerid (omeprazole, sodium bicarbonate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.09.2018

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

Last Modified 08.09.2018

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

Last Modified 08.09.2018

Zenatane (isotretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 10.01.2018

Zenzedi (dextroamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 11.29.2018

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

Last Modified 08.09.2018

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

Last Modified 11.29.2018

Zinbyta (daclizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.09.2018

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

Last Modified 08.09.2018

Zomacton (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.09.2018

Zomacton (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.09.2018

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

Last Modified 08.09.2018

Zonegran (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 12.12.2018

Zorbitive (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans

Last Modified 08.09.2018

Zorbitive (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.09.2018

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

Last Modified 11.30.2018

Zurampic (lesinurad) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans

Last Modified 08.09.2018

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

Last Modified 11.29.2018

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

Last Modified 08.31.2018

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

Last Modified 08.09.2018