Clinical Pharmacy Prior Authorization, Notification and Medical Necessity Requirements - Commercial
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Abilify MyCite (aripiprazole tablet with sensor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.07.2019
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Absorica (isotretinoin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2019
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Abstral (fentanyl sublingual tablets) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.25.2019
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Abstral (fentanyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Actemra (tocilizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Acthar Gel (repository corticotropin injection) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.30.2018
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Acthar Gel (repository corticotropin injection) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Actimmune (interferon gamma-1b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Actiq (brand only) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.25.2019
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Actiq (fentanyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Adcirca (tadalafil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.25.2019
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Adcirca (tadalafil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plan
Last Published 08.27.2019
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Adderall (amphetamine-dextroamphetamine mixed salts) and Adderall XR (amphetamine-dextroamphetamine mixed salts, extended release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Addyi (flibanserin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Adempas (riociguat) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.25.2019
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Adempas (riociguat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Advate (antihemophilic factor [recombinant]) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.25.2019
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Adynovate (antihemophilic factor [recombinant], pegylated) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.25.2019
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Adzenys XR-ODT (amphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Afinitor (everolimus) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Afrezza (insulin, human) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Aimovig (erenumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Aimovig (erenumab) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Ajovy (fremanezumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Ajovy (fremanezumab) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Albenza (albendazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Alecensa (alectinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
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Altreno (tretinoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2019
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Alunbrig™ (brigatinib) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Amitiza (lubiprostone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Ampyra (dalfampridine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Androderm (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Androgel (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Aptensio XR (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Aptiom (eslicarbazepine acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Aptiom (eslicarbazepine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.11.2019
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Arcalyst (rilonacept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Arikayce - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
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Arikayce (amikacin liposome inhalation suspension) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
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Arymo (morphine sulfate extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2019
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Atralin (retinoic) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.25.2019
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Aubagio (teriflunomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Austedo (deutetrabenazine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.25.2019
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Austedo (deutetrabenazine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Avita (retinoic) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.25.2019
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Avonex (teriflunomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Axiron (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Balversa (erdafitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Banzel (rufinamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Belbuca (buprenorphine hydrochloride film) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
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Belviq - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.27.2018
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Belviq XR (lorcaserin extended-release) - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.28.2018
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Benlysta (belimumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.28.2018
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Benzphetamine - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.27.2018
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Berinert (C1 esterase inhibitor, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Betaseron (interferon B-1b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Bethkis (tobramycin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
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Bonjesta - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2018
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Bosulif (bosutinib) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
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Braftovi (encorafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
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Bravelle (urofollitropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Briviact (brivaracetam) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.25.2019
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Briviact Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Bunavail and Suboxone Prior Authorization/Notification – UnitedHealthcare Commercial Plans
Last Published 08.02.2019
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Butrans (buprenorphine patch, extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
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Cablivi® (caplacizumab-yhdp) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Cabometyx (cabozantinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
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Calquence (acalabrutinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Caprelsa (vandetanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2018
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Carbaglu (carglumic acid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Carospir (spironolactone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
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Cayston (aztreonam solution for inhalation) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
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Cerdelga (eliglustat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.28.2018
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Cetrotide (cetrorelix acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Chantix (varenicline) – Tobacco Cessation - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.17.2019
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Cholbam (varenicline) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.28.2018
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Cimzia (certolizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Cinryze (C1 esterase inhibitor, human) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Cinryze (C1 esterase inhibitor, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Clomid (clomiphene citrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Colchicine Tablet (Colcrys authorized generic) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Cometriq (cabozantinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Compounds and Bulk Powders - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Concerta (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Continuous Glucose Monitoring - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.22.2019
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Continuous Glucose Monitors - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Contrave (naltrexone and bupropion) - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.27.2018
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Copaxone (glatiramer acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Copiktra - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
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Corlanor (ivabradine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Cosentyx (secukinumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.15.2019
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Cotellic (cobimetinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Cotempla XR-ODT (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Crinone (progesterone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
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Cystaran (cysteamine) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Daklinza (daclatasvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
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Daklinza (daclatasvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.28.2018
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Daliresp (roflumilast) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Daraprim (pyrimethamine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Daurismo (glasdegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.22.2019
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Daytrana (methyphenidate transdermal) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Depakote and Depakote ER (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.12.2018
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Desoxyn (methamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Devices - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Dexedrine (dextroamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Diabetic Meters and Test Strips - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.02.2019
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Diacomit (stiripentol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Diclegis (doxylamine/pyridoxine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2018
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Diethylpropion - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.28.2018
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Differin (adapalene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.25.2019
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Dolophine - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2019
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Doptelet (avatrombopag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
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Duopa (carbidopa/levodopa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.30.2018
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Dupixent (dupilumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
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Dupixent (dupilumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Duzallo (lesinurad/allopurinol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.26.2019
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Dyanavel XR (amphetamine extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Egrifta (tesamorelin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
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Eligard (leuprolide acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2018
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Eloctate (Antihemophilic Factor Recombinant, Fc Fusion Protein) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.25.2019
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Eloctate (antihemophilic factor recomninant, Fc fusion protein) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Emflaza (deflazacort) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.25.2019
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Emflaza (deflazacort) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Emgality (galcanezumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Emverm (mebendazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Enbrel (etanercept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.22.2019
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Endari (L-glutamine Powder for Solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
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Endometrin (progesterone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
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Entresto (valsartan-sacubitril) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
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Entresto (valsartan-sacubitril) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Epaned (enalapril) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
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Epclusa (sofosbuvir/velpatasvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.25.2019
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Epclusa (sofosbuvir/velpatasvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
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Epidiolex (cannabidiol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
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Epidiolex (cannabidiol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Erivedge (vismodegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.28.2018
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Erleada (apalutamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Esbriet (pirfenidone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.30.2018
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Esbriet (pirfenidone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.28.2018
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Evzio (naloxone hydrochloride) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2019
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Exalgo (hydromorphone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.07.2019
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Exjade (deferasirox) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.28.2018
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Extavia (interferon β-1b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Fabior (tazarotene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.25.2019
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Felbatol (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.12.2018
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Fentanyl citrate powder PA/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.25.2019
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Fentanyl Transdermal - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.12.2019
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Fentora (fentanyl buccal tablet) - Prior Authoriation/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.25.2019
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Fentora (fentanyl buccal tablet) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Ferriprox (deferiprone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.28.2018
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Firazyr (icatibant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Firdapse® (amifampridine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
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FIRST Progesterone VGS (progesterone vaginal suppository compounding kit) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
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Flolipid (simvastatin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
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Focalin (dexmethylphenidate) and Focalin XR (dexmethylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.28.2018
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Follistim AQ (follitropin beta) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Follistim® AQ (follitropin beta) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Fortamet (metformin extended-release, brand and generic) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
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Forteo (teriparatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Fortesta (topical andogens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Fycompa (perampanel) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.25.2019
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Fycompa (perampanel) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Ganirelix Acetate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Gattex (teduglutide [rDNA origin]) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.28.2018
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Genotropin (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.25.2019
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Genotropin (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Gilenya (fingolimod) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Gilotrif (afatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Glatopa (glatiramer acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Glucophage XR (metformin extended-release, brand only) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
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Glumetza (metformin extended-release, brand and generic) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
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Gonal f/Gonal f RFF (follitropin alfa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Gonal-f (follitropin alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Gonal-f RFF (follitropin alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Gonococcal Ophthalmia Neonatorum Prevention - Prior Authorization/Regulatory - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Haegarda (C1 esterase inhibitor Subcutaneous, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Haegarda - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Harvoni (ledipasvir/sofosbuvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Harvoni (ledipasvir/sofosbuvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.02.2019
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Health Care Reform Breast Cancer Prevention Copay Reduction Evista - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Health Care Reform Breast Cancer Prevention Copay Reduction Soltamax - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Health Care Reform Breast Cancer Prevention Copay Reduction Tamoxifen - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Hetlioz (tasimelteon) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Hetlioz (tasimelteon) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Humatrope (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Humatrope (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Humira (adalimumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
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Hycamtin (topotecan hydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Hysingla ER (hydrocodone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.07.2019
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Ibrance (palbociclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Iclusig (ponatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Idhifa (enasidenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
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Ilumya™ (tildrakizumab-asmn) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.15.2019
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Ilumya™ (tildrakizumab-asmn) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.15.2019
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Imbruvica (ibrutinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
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Inbrija (levodopa inhalation powder) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Inbrija (levodopa inhalation powder) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Increlex (mecasermin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Increlex (mecasermin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Infertility Medications (applies to Hawaii) - Prior Authorization/Regulatory - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Ingrezza® (valbenazine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Ingrezza® (valbenazine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Inlyta (axitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2018
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Interim New Product Criteria - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
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Intron-A (interferon alpha-2b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Iressa (gefitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
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Ixinity (coagulation factor IX recombinant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Jadenu (deferasirox) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
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Jatenzo (testosterone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Jivi (antihemophilic factor [recombinant], PEGylated-aucl) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.15.2019
-
Jivi (antihemophilic factor [recombinant], PEGylated-aucl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.15.2019
-
Jornay PM (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Jublia (efinaconazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Juxtapid (lomitapide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.02.2019
-
Juxtapid (lomitapide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.02.2019
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Jynarque (tolvaptan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
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Kadian (morphine sulfate sustained-release capsule) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.07.2019
-
Kalydeco (ivacaftor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
-
Kalydeco (ivacaftor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
-
Kerydin (tavaborole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Keveyis (dichlorphenamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Kevzara (sarilumab) Injection - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Kisqali (ribociclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
-
Kisqali® Femara® Co-Pack (ribociclib/letrozole) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.27.2018
-
Kitabis Pak (tobramycin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Kuvan (sapropterin dihydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Kynamro (mipomersen sodium) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.30.2018
-
Lamictal and Lamictal XR (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.12.2018
-
Lamictal ODT (brand and generic) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.19.2018
-
Lazanda (fentanyl nasal spray) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Lazanda (fentanyl nasal spray) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Lenvima (lenvatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Letairis (ambrisentan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.12.2019
-
Letairis (ambrisentan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Leuprolide Acetate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2018
-
Lokelma (sodium zirconium cyclosilicate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2019
-
Lonhala Magnair (glycopyrrolate nebulized solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Lonsurf (trifluridine/tipiracil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Lorbrena (lorlatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.26.2019
-
Lotronex (Alosteron) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Lucemyra (lofexidine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
-
Mavenclad® (cladribine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Mavenclad® (cladribine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Mavyret (glecaprevir/pibrentasvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Mavyret™ (glecaprevir/pibrentasvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Mayzent ® (siponimod) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Mayzent® (siponimod) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Mektovi (binimetinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
-
Menopur (menotropins) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Menopur® (menotropins) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Metadate (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Metadate CD (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Methylin and Methylin ER (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Minocycline extended-release tablet (generic Solodyn), - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
-
Minolira* (minocycline extended-release tablet) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
-
Morphabond ER (morphine sulfate extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.07.2019
-
Morphine Sulfate (generic MS Contin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.07.2019
-
Motegrity (prucalopride) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Movantik (naloxegol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
MS Contin (long-acting opioid analgesic) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.07.2019
-
Multaq (dronedarone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Myalept (metreleptin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Myalept (metreleptin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Mydayis (dextroamphetamine-amphetamine mixed salts) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Mysoline (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.12.2018
-
Mytesi (crofelemer) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Natesto (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Natpara (parathyroid hormone analog) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.30.2018
-
Natpara (parathyroid hormone analog) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
-
Nerlynx (neratinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
-
Neurontin (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.12.2018
-
New & Therapeutic Equivalent Medications - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.07.2019
-
New and Therapeutic Equivalent Medications - Excluded Drug - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.07.2019
-
Nexavar (sorafenib tosylate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2018
-
Nexium (esomeprazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Nicotine Gum / Lozenge / Patch - Prior Authorization - UnitedHealthcare Commercial Plans
Last Published 03.12.2019
-
Nicotrol Inhaler (nicotine inhalation system) – Tobacco Cessation - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.06.2019
-
Nicotrol NS (nicotine nasal spray) – Tobacco Cessation - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.06.2019
-
Nityr (nitisinone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
-
Nocdurna (desmopressin acetate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Noctiva (desmopressin acetate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Non-Formulary Copay Adjustment Notification (applies to New Jersey) - Prior Authorization/Regulatory - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
NordiFlex (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
NordiFlex (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Norditropin (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Norditropin (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Northera (droxidopa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Novarel (chorionic gonadotropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Nucynta ER (tapentadol extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.07.2019
-
Nuedexta (dextromethorphan/quinidine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Nuplazid (pimavanserin tartrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.11.2018
-
Nutropin and Nutropin AQ (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Nutropin AQ (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Nutropin AQ NuSpin (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Nutropin AQ NuSpin (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
NuvaRing (etonogestrel / ethinyl estradiol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Nuvigil (armodafinil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.26.2019
-
Ocaliva (obeticholic acid) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Ocaliva (obeticholic acid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Odomzo (sonidegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
-
Ofev (nintedanib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.30.2018
-
Ofev (nintedanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
-
Olumiant - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Olumiant® (baricitinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.11.2019
-
Olysio (simeprevir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.17.2018
-
Omnitrope (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Omnitrope (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Onfi (clobazam) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Opana ER (oxymorphone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.07.2019
-
Opioid Containing Cough & Cold Medicines PA/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.06.2019
-
Opsumit (macitentan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Opsumit (macitentan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Orencia (abatacept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
-
Orenitram (treprostinil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Orenitram (treprostinil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Orfadin (nitisinone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Orkambi (lumacaftor-ivacaftor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
-
Orkambi (lumacaftor-ivacaftor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
-
OrthoEvra (norelgestromin-ethinyl estradiol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Ovidrel (choriogonadotropin alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Oxervate (cenegermin-bkbj) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
-
Oxervate (cenegermin-bkbj) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
-
Oxistat (oxiconazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.30.2018
-
Oxtellar (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.12.2018
-
OxyContin (oxycodone controlled-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.07.2019
-
Palynziq (pegvaliase-pqpz) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Palynziq - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
PEG-Intron (peginterferon alfa-2b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Pegasys (peginterferon alfa-2a) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Phendimetrazine - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.27.2018
-
Phentermine - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.10.2018
-
Plegridy (peginterferon)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Pomalyst (pomalidomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Praluent (alirocumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.26.2019
-
Praluent (alirocumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Pregnyl (chorionic gonadotropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Prevacid SoluTab (lansoprazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Prevymis (letermovir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Procentra (dextroamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Procysbi (cysteamine bitartrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Progesterone bulk powder - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.06.2019
-
Promacta (eltrombopag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Provigil (modafanil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.26.2019
-
Prudoxin (doxepin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.26.2019
-
Pulmozyme (dornase alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Purixan (mercaptopurine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Qbrelis (lisinopril) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Qsymia (phentermine, topiramate extended-release) - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
-
Qudexy XR (multisource brand/modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.19.2018
-
QuilliChew ER (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Quillivant XR (methylphenidate extendedrelease) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Ravicti (glycerol phenylbutyrate oral liquid) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
-
Ravicti (glycerol phenylbutyrate oral liquid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
-
Rebif (interferon β-1a) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Recombinate (antihemophilic factor [recombinant]) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
-
Regranex (becaplermin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
-
Relistor (methylnaltrexone bromide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Repatha (evolocumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.15.2019
-
Repatha (evolocumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Retin-A (tretinoin) / Retin-A Micro (tretinoin microspheres) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.25.2019
-
Revatio (sildenafil citrate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
-
Revatio (sildenafil citrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Revlimid (lenalidomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Rexulti (brexpiprazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Rhofade (oxymetazoline) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Ritalin (methylphenidate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Ritalin LA (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Ritalin SR (methylphenidate extended-release) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Rubraca (rucaparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
-
Ruconest (C1 esterase inhibitor recombinant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Ruzurgi® (amifampridine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Rydapt™ (midostaurin) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Sabril (vigabatrin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Saizen (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
-
Saizen (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Sandostatin (octreotide acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
-
Saxenda (liraglutide) - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.27.2018
-
Selzentry (maraviroc) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
-
Sensipar (cinacalcet) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.12.2018
-
Serostim (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
-
Serostim (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Signifor (pasireotide diaspartate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
-
Siliq (brodalumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Siliq (brodalumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.15.2019
-
Sodium Phenylbutyrate (Buphenyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.27.2019
-
Solaraze (diclofenac 3% gel) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Soliqua (insulin glargine/lixisenatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Solodyn (generic minocycline extended-release tablet) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
-
Somavert (pegvisomant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Somavert (pegvisomant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Sotylize (sotalol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Sovaldi (sofosbuvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.02.2019
-
Sovaldi (sofosbuvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
-
Spravato™ (esketamine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.03.2019
-
Spravato™ (esketamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.07.2019
-
Spritam (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.12.2018
-
Sprycel (dasatinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
-
Sprycel (dasatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Stelara (ustekinumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Stivarga (regorafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Strensiq (asfotase alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Strensiq® (asfotase alfa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Striant (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Subsys (fentanyl sublingual spray) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Subsys (fentanyl sublingual spray) - Prior Notification/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
-
Sunosi™ (solriamfetol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Sunosi™ (solriamfetol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
-
Sylatron (peginterferon alfa-2b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Symdeko (texacaftor / ivacaftor) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
-
Symdeko - (tezacaftor /ivacaftor,) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
-
Sympazan (clobazam) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Syndros (dronabinol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
-
Syprine (trientine hydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Tagrisso (osimertinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Takhzyro™ (lanadelumab-flyo) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
-
Taltz (ixekizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.15.2019
-
Taltz (ixekizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.15.2019
-
Talzenna (talazoparib) - Prior Authorization/Notification - UnitedHealthcare Commercial PlansOpens in a new window
Last Published 02.27.2019
-
Tarceva (erlotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Tasigna (nilotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
-
Tavalisse (fostamatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
-
Tazorac (tazarotene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.25.2019
-
Tecfidera (dimethyl fumarate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
-
Technivie (ombitasvir, paritaprevir, ritonavir tablets) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
-
Tegsedi - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
-
Tegsedi™ (inotersen) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
-
Temodar (temozolomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
-
Testim (topical androgens) -i Pror Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
-
Testosterone - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
-
Tetrabenazine (Xenazine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.27.2019
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Thalomid (thalidomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Tibsovo® (ivosidenib) Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Tiglutik (riluzole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
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TOBI (tobramycin inhalation solution-powder) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
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Topamax (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.12.2018
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Tracleer (bosentan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
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Tracleer (bosentan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Tremfya (guselkumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
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Tretin-X (tretinoin-cleanser) - Prior Authorization/Notification - UnitedHealthcare
Last Published 03.25.2019
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Trileptal (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.12.2018
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Trokendi XR (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.12.2018
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Tykerb (lapatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
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Tymlos (abaloparatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Tyvaso (treprostinil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
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Tyvaso (treprostinil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Ultravate Lotion (halobetasol propionate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
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Uptravi (selexipag) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
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Uptravi (selexipag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Valchlor (mechlorethamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
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Vanatol LQ (butalbital, acetaminophen and caffeine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
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Vecamyl (mecamylamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Veltassa (patiromer) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.27.2019
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Venclexta (venetoclax) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Ventavis (iloprost) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
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Ventavis (iloprost) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Vermox (mebendazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Verzenio™ (abemaciclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Viekira Pak (ombitasvir, paritaprevir, ritonavir, dasabuvir tablets) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.06.2019
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Viekira Pak (ombitasvir, paritaprevir, ritonavir, dasabuvir tablets) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.06.2019
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Vimpat (lacosamide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
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Vimpat (lacosamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Vitrakvi (larotrectinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.22.2019
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Vizimpro - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
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Vogelxo (topical androgens) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Vosevi (sofosbuvir, velpatasvir, and voxilaprevir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
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Vosevi (sofosbuvir, velpatasvir, and voxilaprevir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Votrient (pazopanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Vyndamax (tafamidis) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Vyndamax (tafamidis) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Vyndaqel® (tafamidis meglumine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Vyndaqel® (tafamidis meglumine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Vyvanse (lisdexamfetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Xadago (safinamide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
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Xalkori (crizotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.25.2019
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Xatmep (methotrexate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
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Xeljanz / Xeljanz XR (tofacitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Xenical (orlistat) - CA & NY Regulatory Program Weight Loss - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.27.2018
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Xermelo (telotristat ethyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Xifaxan (rifaximin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Ximino (minocycline extended-release capsule) - Prior Authorization/Medical Neccessity - UnitedHealthcare Commercial Plans
Last Published 04.29.2019
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Xospata (gilteritinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
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Xtampza ER (oxycodone extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.07.2019
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Xtandi (enzalutamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.31.2018
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Xuriden (uridine triacetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Xyosted - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Xyrem (sodium oxybate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2018
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Xyrem (sodium oxybate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2018
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Yonsa (abiraterone acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.01.2019
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Yupelri (revefenacin inhalation solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Zegerid (omeprazole, sodium bicarbonate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 05.28.2019
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Zejula (niraparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019
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Zenzedi (dextroamphetamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.26.2019
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Zepatier (elbasvir, grazoprevir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
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Zepatier (elbasvir, grazoprevir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.30.2019
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Zomacton (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
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Zomacton (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Zonalon (doxepin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.27.2019
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Zonegran (multisource brand-modified release anticonvulsants) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.12.2018
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Zorbitive (somatropin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.29.2019
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Zorbitive (somatropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 01.28.2019
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Zovirax Ointment (acyclovir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.30.2018
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Zurampic (lesinurad) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.27.2019
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Zydelig (idelalisib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.29.2018
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Zykadia (ceritinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2019
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Zytiga (abiraterone acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.29.2019