Clinical Pharmacy Prior Authorization, Notification and Medical Necessity Requirements - Commercial
Inclusion in this list does not indicate a drug is covered by a particular plan. Any drug may be subject to other requirements including but not limited to Exclude at Launch and or Review at Launch.
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Abilify MyCite® (aripiprazole tablet with sensor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Absorica® (isotretinoin), Absorica LD® (isotretinoin micronized), isotretinoin 25 mg and 35 mg (generic Absorica) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Actemra® (tocilizumab) and Tyenne® (tocilizumab-aazg) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
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Actemra® (tocilizumab) and Tyenne® (tocilizumab-aazg) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
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Actimmune® (interferon gamma-1b) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
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Adalimumab - Abrilada™ (adalimumab-afzb), Adalimumab-aacf (unbranded Idacio), Adalimumab-adaz (unbranded Hyrimoz), Adalimumab-adbm (unbranded Cyltezo), Adalimumab-fkjp (unbranded Hulio), Amjevita™ (adalimumab-atto), Cyltezo® (adalimumab-adbm), Hadlima™ (adalimumab-bwwd), Hulio® (adalimumab-fkjp), Humira® (adalimumab), Hyrimoz® (adalimumab-adaz), Idacio® (adalimumab-aacf), Simlandi® (adalimumab-ryvk), Yuflyma® (adalimumab-aaty), and Yusimry™ (adalimumab-aqvh) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Adalimumab - Abrilada™ (adalimumab-afzb), Adalimumab-aacf (unbranded Idacio), Adalimumab-adaz (unbranded Hyrimoz), Adalimumab-adbm (unbranded Cyltezo), Adalimumab-fkjp (unbranded Hulio), Amjevita™ (adalimumab-atto), Cyltezo® (adalimumab-adbm), Hadlima™ (adalimumab-bwwd), Hulio® (adalimumab-fkjp), Humira® (adalimumab), Hyrimoz® (adalimumab-adaz), Idacio® (adalimumab-aacf), Simlandi® (adalimumab-ryvk), Yuflyma® (adalimumab-aaty), and Yusimry™ (adalimumab-aqvh) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Adbry™ (tralokinumab-ldrm) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Adbry™ (tralokinumab-ldrm) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Addyi™ (flibanserin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Adynovate® (antihemophilic factor [recombinant], pegylated)- Prior Authorizatin/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
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Afinitor® (everolimus) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
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Afrezza® (insulin human) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.19.2024
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Afstyla® (antihemophilic factor [recombinant], single chain) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Agamree® (vamorolone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Agamree® (vamorolone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Akeega™ (niraparib and abiraterone acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Aklief® (trifarotene) cream - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
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Albenza (albendazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.01.2024
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Albuterol tablets - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Altuviiio™ [antihemophilic factor (recombinant), Fc-VWF-XTEN fusion protein-ehtl] - Prior Authorization/Medical Necessity - UnitedHealth Commercial Plans
Last Published 07.01.2024
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Alunbrig® (brigatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.17.2024
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Alvaiz™ (eltrombopag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Alyftrek™ (vanzacaftor/tezacaftor/deutivacaftor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Alyftrek™ (vanzacaftor/tezacaftor/deutivacaftor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Amlodipine/valsartan/hydrochlorothiazide (generic Exforge HCT®) - Prior Authorization/Non-Formulary - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Ampyra® (dalfampridine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
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Anticonvulsants - Aptiom® (eslicarbazepine acetate), Banzel® (rufinamide), Briviact® (brivaracetam), Diacomit® (stiripentol), Epidiolex® (cannabidiol), Fintepla® (fenfluramine), Fycompa® (perampanel), Libervant™ (diazepam), Nayzilam® (midazolam), Onfi® (clobazam), Sabril® (vigabatrin), Sympazan® (clobazam), Valtoco® (diazepam), Xcopri® (cenobamate), Ztalmy® (ganaxolone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
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Apokyn® (apomorphine) injection - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
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Apokyn® (apomorphine) injection - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
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Aqneursa™ (levacetylleucine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
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Aqneursa™ (levacetylleucine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
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Arcalyst® (rilonacept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
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Arikayce® (amikacin liposome inhalation suspension) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Arikayce® (amikacin liposome inhalation suspension) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Attruby™ (acoramidis) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
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Attruby™ (acoramidis) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
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Augtyro™ (repotrectinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.01.2024
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Austedo® (deutetrabenazine), Austedo® XR (deutetrabenazine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
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Austedo® (deutetrabenazine), Austedo® XR (deutetrabenazine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
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Ayvakit® (avapritinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Balversa® (erdafitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
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Benlysta® (belimumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Benznidazole - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Berinert® (C1 esterase inhibitor [human]) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
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Berinert® (C1 esterase inhibitor, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Besremi® (ropeginterferon alfa-2b-njft) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Bethkis®, Kitabis® Pak, TOBI™ Nebulizer Solution and TOBI® Podhaler™, tobramycin solution for inhalation - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.12.2024
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Bimzelx® (bimekizumab-bkzx) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
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Bimzelx® (bimekizumab-bkzx) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
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Bonjesta® (doxylamine/pyridoxine extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.01.2024
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Bosulif® (bosutinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Braftovi® (encorafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Brexafemme® (ibrexafungerp) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Bronchitol® (mannitol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Brukinsa® (zanubrutinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Buphenyl® (sodium phenylbutyrate), Olpruva™ (sodium phenylbutyrate), Pheburane® (sodium phenylbutyrate), sodium phenylbutyrate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Buprenorphine Products - Belbuca® (buprenorphine hydrochloride film) and Butrans® (buprenorphine patch, extended-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Bylvay™ (odevixibat) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.01.2024
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Bylvay™ (odevixibat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.01.2024
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Cablivi® (caplacizumab-yhdp) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
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Cabometyx® (cabozantinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.15.2025
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Calquence® (acalabrutinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
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Camzyos® (mavacamten) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.01.2024
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Camzyos® (mavacamten) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.01.2024
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Caplyta® (lumateperone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Caplyta® (lumateperone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Caprelsa® (vandetanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Carbaglu® (carglumic acid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Cardiovascular Disease Prevention Prior Authorization - UnitedHealthcare Commercial Plans
Last Published 04.01.2024
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Cayston® (aztreonam for inhalation solution) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Cerdelga® (eliglustat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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CGRP Receptor Antagonists - Aimovig® (erenumab), Ajovy® (fremanezumab), Emgality® (galcanezumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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CGRP Receptor Antagonists - Aimovig® (erenumab), Ajovy® (fremanezumab), Emgality® (galcanezumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Cholbam™ (cholic acid) - Prior Authorization/Notification - UnitedHealthcare Comemercial Plans
Last Published 08.01.2024
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Cibinqo™ (abrocitinib) tablets - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Cibinqo™ (abrocitinib) tablets - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Cimzia® (certolizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Cimzia® (certolizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Cinryze® (C1 esterase inhibitor, human) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Cinryze® (C1 esterase inhibitor, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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CNS Depressants - Lumryz™ (sodium oxybate), sodium oxybate [Xyrem authorized generic (manufactured by Amneal)], sodium oxybate [Xyrem authorized generic (manufactured by Hikma)], Xyrem® (sodium oxybate), Xywav™ (calcium, magnesium, potassium, and sodium oxybates) - Pior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2024
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CNS Depressants - Lumryz™ (sodium oxybate), sodium oxybate [Xyrem authorized generic (manufactured by Amneal)], sodium oxybate [Xyrem authorized generic (manufactured by Hikma)], Xyrem® (sodium oxybate), Xywav™ (calcium, magnesium, potassium, and sodium oxybates) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2024
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Cobenfy™ (xanomeline and trospium chloride) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
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Cometriq® (cabozantinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
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Compounds and Bulk Powders - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Constipation Agents - Amitiza® (lubiprostone), Ibsrela® (tenapanor), Linzess® (linaclotide), Motegrity® (prucalopride), Movantik® (naloxegol), Symproic® (naldemedine), Trulance® (plecanatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.07.2024
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Continuous glucose monitors, sensors and transmitters (all brands) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Continuous Glucose Monitors, sensors and transmitters (all brands) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Contraceptive Medications - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2024
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COPD - Lonhala Magnair® (glycopyrrolate inhalation solution), Yupelri® (revefenacin inhalation solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2024
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Copiktra® (duvelisib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
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Corlanor® (ivabradine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
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Cosentyx®(secukinumab) prefilled syringe or Sensoready pen - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Cosentyx™ (secukinumab) prefilled syringe or Sensoready pen - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
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Cotellic® (cobimetinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.15.2025
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Crenessity™(crinecerfont) oral capsule and oral suspension - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
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Crenessity™(crinecerfont) oral capsule and oral suspension - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
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Cuvrior™ (trientine tetrahydrochloride) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Cuvrior™ (trientine tetrahydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Cystaran® (cysteamine) ophthalmic solution, Cystadrops® (cysteamine) ophthalmic solution - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Danziten™ (nilotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
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Daraprim® (pyrimethamine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
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Daurismo™ (glasdegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
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Daybue™ (trofinetide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
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Daybue™ (trofinetide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
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Demser® (metyrosine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Devices - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Diabetes Medications – GLP-1 & Dual GIP/GLP-1 Receptor Agonists - Bydureon BCise (exenatide extended-release), Byetta (exenatide), Mounjaro (tirzepatide), Ozempic (semaglutide), Rybelsus (semaglutide), Trulicity (dulaglutide), Victoza (liraglutide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.01.2024
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Diabetic Meters and Test Strips - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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dichlorphenamide, Keveyis® (dichlorphenamide), Ormalvi™ (dichlorphenamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Diclegis® (doxylamine/pyridoxine delayed-release) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.01.2024
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Digital Applications - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
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Dojolvi® (triheptanoin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
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Dojolvi® (triheptanoin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
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Doptelet® (avatrombopag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
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Doxepin cream - Prudoxin® (doxepin), Zonalon® (doxepin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Doxepin cream - Prudoxin® (doxepin), Zonalon® (doxepin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Dry Eye Disease - Cequa™ (cyclosporine 0.09% ophthalmic solution), Miebo™ (perfluorohexyloctane), Restasis® (cyclosporine 0.05% ophthalmic emulsion), Restasis MultiDose™ (cyclosporine 0.05% ophthalmic emulsion), Tyrvaya™ (varenicline nasal spray), Vevye™ (cyclosporine 0.1%), Xiidra® (lifitegrast 5% ophthalmic solution) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.18.2024
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Dry Eye Disease - Cequa™ (cyclosporine 0.09% ophthalmic solution), Restasis® MultiDose™ (cyclosporine 0.05% ophthalmic emulsion), Tyrvaya™ (varenicline nasal spray), Vevye™ (cyclosporine 0.1%) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.18.2024
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Duopa™ (carbidopa/levodopa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.01.2024
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Dupixent® (dupilumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Dupixent® (dupilumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Duvyzat™ (givinostat) oral suspension - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Duvyzat™ (givinostat) oral suspension - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Ebglyss™ (lebrikizumab-lbkz) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Ebglyss™ (lebrikizumab-lbkz) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Egrifta SV™ (tesamorelin for injection) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Eloctate® [antihemophilic factor (recombinant), Fc fusion protein] - Prior Authorization/Medical Necessity - UnitedHealth Commercial Plans
Last Published 12.01.2024
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Emflaza® (deflazacort) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Emflaza® (deflazacort) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Empaveli® (pegcetacoplan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
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Empaveli® (pegcetacoplan) - Prior Authorization/Notification - UniteedHealthcare Commercial Plans
Last Published 07.01.2024
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Emverm (mebendazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.01.2024
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Enbrel® (etanercept) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Enbrel® (etanercept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Endari® (L-glutamine Powder for Solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Ensacove (ensartinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Enspryng™ (satralizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Enspryng™ (satralizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Entresto® (valsartan-sacubitril) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Entresto® (valsartan-sacubitril) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
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Entyvio® (vedolizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Entyvio® (vedolizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
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Envarsus XR™ (tacrolimus extended-release tablets) - Prior Authorization/Non-Formulary - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
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Eohilia™ (budesonide oral suspension) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
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Epclusa® (sofosbuvir/velpatasvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Epclusa® (sofosbuvir/velpatasvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.01.2024
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Epsolay® (benzoyl peroxide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.01.2024
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Erivedge® (vismodegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Erleada® (apalutamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Esperoct® (antihemophilic factor [recombinant], glycopegylated-exei) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Evrysdi® (risdiplam) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
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Evrysdi®(risdiplam) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
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Fabhalta® (iptacopan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Fabhalta® (iptacopan) - Prior Authorization/Notification - UniteedHealthcare Commercial Plans
Last Published 12.18.2024
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Fasenra® (benralizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Fasenra™ (benralizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Fentanyl - Actiq® (brand only) (fentanyl transmucosal lozenge), Fentora® (fentanyl buccal tablet), and fentanyl citrate bulk powder - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Fentanyl - Actiq® (fentanyl transmucosal lozenge), Fentora® (fentanyl buccal tablet), and fentanyl citrate - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
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Filspari™ (sparsentan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Filsuvez® (birch triterpenes) topical gel - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Filsuvez® (birch triterpenes) topical gel - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Firazyr® (icatibant), icatibant, Sajazir™ (icatibant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.19.2024
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Firazyr® (icatibant), icatibant, Sajazir™ (icatibant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Firdapse® (amifampridine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Firdapse® (amifampridine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Fluticasone propionate HFA - Non-Formulary - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Follicle-stimulating Hormone (FSH) - Follistim® AQ (follitropin beta), Gonal-f™ (follitropin alfa), Gonal-f™ RFF (follitropin alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Follistim®AQ (follitropin beta), Gonal-f™ (follitropin alfa), Gonal-f™ RFF (follitropin alfa), Menopur® (menotropins) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Forteo® (teriparatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Fotivda® (tivozanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Fruzaqla™ (fruquintinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Furoscix® (furosemide injection) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Fuzeon® (enfuvirtide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Galafold® (migalastat) (migalastat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Gattex® (teduglutide [rDNA origin]) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
-
Gavreto™ (pralsetinib) - Prior Authorizatin/Notification - UnitedHealthcare Commercial Plans
Last Published 02.15.2025
-
Gilotrif® (afatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Gleevec® (imatinib mesylate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Gonadotropin-releasing hormone (GnRH) Antagonists - Cetrotide® (cetrorelix acetate) and ganirelix acetate - Prior Authorizatin/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Gonococcal Ophthalmia Neonatorum (GON) Prevention Zero Dollar Cost Share – erythromycin 0.5% ophthalmic ointment - Prior Authorization - UnitedHealthcare Commercial Plans
Last Published 08.06.2024
-
Haegarda® (C1 esterase inhibitor Subcutaneous, human) - Prior Authorization/Notification - UnitedHealthcare Commercial Plan
Last Published 06.01.2024
-
Haegarda® (C1 esterase inhibitor, human) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Harvoni® (ledipasvir/sofosbuvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Harvoni® (ledipasvir/sofosbuvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Hemlibra® (emicizumab-kxwh) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
-
Hemlibra® (emicizumab-kxwh) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Hetlioz®, Hetlioz LQ™ (tasimelteon) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.01.2024
-
Hetlioz®, Hetlioz LQ™ (tasimelteon) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2024
-
HIV Pre-exposure Prophylaxis (PrEP) Zero Dollar Cost Share – generic tenofovir disoproxil fumarate - Prior Authorization - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
-
human chorionic gonadotropin (hCG) - Novarel® (chorionic gonadotropin), Ovidrel® (choriogonadotropin alfa), and Pregnyl® (chorionic gonadotropin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
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Human Growth Hormone - Somatropin (Genotropin®, Humatrope®, Norditropin®, Nutropin AQ NuSpin®, Omnitrope®, Saizen®, Serostim®, Zomacton®, Zorbtive®, Skytrofa™, (lonapegsomatropin-tcgd), Sogroya®(somapacitan-beco), Ngenla™ (somatrogon-ghla). Growth Stimulating Products - Mecasermin (Increlex®) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Human Growth Hormone - Somatropin (Genotropin®, Humatrope®, Norditropin®, Nutropin AQ® NuSpin®, Omnitrope®, Saizen®, Serostim®, Zomacton®, Zorbtive®, Skytrofa™ (lonapegsomatropin-tcgd), Sogroya® (somapacitan-beco), Ngenla™ (somatrogon-ghla). Growth Stimulating Products - Mecasermin (Increlex®) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Hycamtin® (topotecan hydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Hyftor® (sirolimus topical gel) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
-
Ibrance® (palbociclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Ibsrela® (tenapanor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Iclusig® (ponatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Idhifa® (enasidenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.17.2024
-
Idiopathic Pulmonary Fibrosis - Esbriet® (pirfenidone) and Ofev® (nintedanib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Idiopathic Pulmonary Fibrosis - Esbriet® (pirfenidone) and Ofev® (nintedanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 05.31.2024
-
Ilumya™ (tildrakizumab-asmn) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Ilumya™ (tildrakizumab-asmn) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Imbruvica® (ibrutinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Impavido (miltefosine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Inbrija® (levodopa inhalation powder) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Inbrija® (levodopa inhalation powder) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Ingrezza® (valbenazine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
-
Ingrezza® (valbenazine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
-
Inlyta® (axitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.17.2024
-
Inqovi® (decitabine and cedazuridine) tablet - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Inrebic® (fedratinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Interim New Product Coverage Criteria - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
-
Intrarosa® (prasterone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Invokana® (canagliflozin) - Non-Formulary - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Iressa® (gefitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Iron Chelators - Exjade® (deferasirox), Jadenu® (deferasirox), and Ferriprox® (deferiprone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Isturisa® (osilodrostat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Itovebi™ (inavolisib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
-
Iwilfin™ (eflornithine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Ixinity [coagulation factor IX (recombinant)] - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Jakafi® (ruxolitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.15.2025
-
Javygtor™ (sapropterin dihydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Jaypirca® (pirtobrutinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Jesduvroq® (daprodustat) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.01.2024
-
Jesduvroq® (daprodustat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2024
-
Jivi® (antihemophilic factor [recombinant], PEGylated-aucl) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
-
Joenja® (leniolisib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Joenja® (leniolisib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Juxtapid® (lomitapide) - Prior Authorization - Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Juxtapid® (lomitapide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Jynarque® (tolvaptan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.01.2024
-
Kalydeco® (ivacaftor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Kalydeco® (ivacaftor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Kerendia® (finerenone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Kerendia® (finerenone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Kevzara® (sarilumab) Injection - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Kevzara® (sarilumab) Injection - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.01.2024
-
Kineret® (anakinra) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Kisqali® (ribociclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.15.2025
-
Kisqali® Femara® Co-Pack (ribociclib/letrozole) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.15.2025
-
Korlym® (mifepristone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Koselugo™ (selumetinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
-
Krazati™ (adagrasib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.01.2024
-
Kuvan® (sapropterin dihydrochloride) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Lampit® (nifurtimox) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Lazcluze™ (lazertinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.07.2025
-
Lenvima® (lenvatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Leuprolide acetate (bulk powder, 1 mg/0.2 mL injection) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Levemir® (insulin detemir) - Prior Authorizatin/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Lidocaine Patch (Lidoderm®), ZTLido™ - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Litfulo™ (ritlecitinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
-
Litfulo™ (ritlecitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
-
Lithobid® (brand only) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Livdelzi® (seladelpar) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
-
Livdelzi® (seladelpar) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
-
Livmarli™ (maralixibat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
-
Livmarli™ (maralixibat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
-
Livtencity (maribavir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Lokelma® (sodium zirconium cyclosilicate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Long-Acting Opioid Pain Medications - fentanyl transdermal patch (generic Duragesic®) 12, 25, 50, 75, 100 mcg/hr, fentanyl transdermal patch 37.5, 62.5, 87.5 mcg/hr, hydrocodone extended-release capsules (generic ZohydroTM ER), hydrocodone extended-release tablets (generic HysinglaTM ER), hydromorphone extended-release (generic Exalgo®), Hysingla ER, methadone, morphine sulfate controlled-release capsules (generic Avinza®), morphine sulfate controlled-release tablets (generic MS Contin®), morphine sulfate sustained-release capsules (generic Kadian®), MS Contin, Nucynta® ER (tapentadol extended-release), oxycodone controlled-release (authorized generic for OxyContin®), OxyContin^, oxymorphone extended-release (generic Opana® ER), Xtampza® ER (oxycodone extended-release) – Prior Authorization/Medical Necessity – UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Lonsurf® (trifluridine/tipiracil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
-
Lorbrena® (lorlatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Lotronex® (alosetron) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
-
Lumakras™ (sotorasib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Lupkynis™ (voclosporin) - Prior Authoization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Lupkynis™ (voclosporin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Lybalvi™ (olanzapine/samidorphan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Lynparza® (olaparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Lytgobi® (futibatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.15.2025
-
Mavenclad® (cladribine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
-
Mavyret® (glecaprevir/pibrentasvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Mavyret® (glecaprevir/pibrentasvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.01.2024
-
Mekinist® (trametinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Mektovi® (binimetinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
-
Menopur® (menotropins) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Methyldopa - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Mifeprex (mifepristone) - Benefit Determination - UnitedHealthcare Commercial Plans
Last Published 05.31.2024
-
Migraine - Dihyroergotamine nasal spray (Migranal®), Ergomar® (ergotamine), Trudhesa® (dihydroergotamine nasal spray) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Migraine - Nurtec® ODT (rimegepant), Qulipta™ (atogepant), Ubrelvy™ (ubrogepant), Zavzpret™ (zavegepant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Migraine - Nurtec® ODT (rimegepant), Qulipta™ (atogepant), Ubrelvy™ (ubrogepant), Zavzpret™ (zavegepant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Miplyffa™ (arimoclomol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
-
Miplyffa™ (arimoclomol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
-
Mirvaso® (brimonidine gel) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Motegrity® (prucalopride) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Movantik® (naloxegol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Mulpleta® (lusutrombopag) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Mulpleta® (lusutrombopag) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Multaq® (dronedarone) - Prior Authorization/Notification - UnitedHealthcare Commrcial Plans
Last Published 12.18.2024
-
Multiple Sclerosis - Aubagio® (teriflunomide), Avonex® (interferon β-1a), Bafiertam™ (monomethyl fumarate), Betaseron® (interferon β-1b), Copaxone® (glatiramer acetate), dimethyl fumarate, Extavia® (interferon β-1b), fingolimod, Gilenya® (fingolimod), Glatopa™ (glatiramer acetate), glatiramer acetate, Kesimpta (ofatumumab), Mayzent (siponimod)®, Plegridy™ (peginterferon β-1a), Ponvory™ (Ponesimod), Rebif® (interferon β-1a), Tascenso ODT™ (fingolimod), Tecfidera™ (dimethyl fumarate), teriflunomide, Vumerity™ (diroximel fumarate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Multisource Brand/Modified Release Anticonvulsants – Banzel®, Depakote®, Depakote ER®, Felbatol®, Keppra®, Keppra XR®, Lamictal, Lamictal XR, Lamictal ODT (brand and generic), Lyrica®, Motpoly XR, Mysoline®, Neurontin®, Onfi®, Sabril®, Topamax®, Trileptal®, Vimpat®, Zonegran®- Prior Athorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.19.2024
-
Myalept® (metreleptin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Myalept® (metreleptin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Mycapssa® (octreotide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
-
Mycapssa™ (octreotide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
-
Mytesi™ (crofelemer) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Natpara® (parathyroid hormone analog) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.17.2024
-
Natpara® (parathyroid hormone analog) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.17.2024
-
Nerlynx® (neratinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
New and Therapeutic Equivalent Medications - Excluded Drug - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
New and Therapeutic Equivalent Medications - Prior Authorization - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Nexavar® (sorafenib tosylate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
-
Nexletol® (bempedoic acid), Nexlizet ® (bempedoic acid/ezetimibe) - Pruir Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Ninlaro® (ixazomib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Nityr® (nitisinone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
-
Nocdurna® (desmopressin acetate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Non-Solid Oral and Suppository Dosage Forms - Alkindi® Sprinkle (hydrocortisone), Aspruzyo Sprinkle™ (ranolazine), Atorvaliq® (atorvastatin), Carafate® (sucralfate) suspension, Carospir® (spironolactone), chlorpromazine oral solution, Epaned® (enalapril), Eprontia® (topiramate), Ermeza™ (levothyroxine), Ezallor Sprinkle™ (rosuvastatin), Fleqsuvy® (baclofen), Flolipid (simvastatin), Indocin® (indomethacin) suspension, Indocin (indomethacin) suppository, Jylamvo (methotrexate), Katerzia® (amlodipine), Lyvispah® (baclofen), Meloxicam (meloxicam) suspension, Naprosyn® (naproxen) suspension, Nexium® for suspension (esomeprazole), Norliqva® (amlodipine), Ozobax DS (baclofen), Pradaxa® (dabigatran) oral pellets, Prevacid® SoluTab™ (lansoprazole), Prograf® Granules (tacrolimus), Qbrelis® (lisinopril), Qdolo™ (tramadol), Renvela® (sevelamer carbonate) powder for suspension, Sotylize® (sotalol), Sympazan (clobazam)®, Syndros® (dronabinol), Tiglutik® (riluzole), Tirosint®-Sol (levothyroxine), Valsartan oral solution, Xatmep® (methotrexate), Xelstrym™ (dextroamphetamine), Zegerid® for suspension (omeprazole and sodium bicarbonate)*, Zonisade® (zonisamide)
Last Published 04.22.2025
-
Northera® (droxidopa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
-
Nourianz (istradefylline) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
-
Nubeqa® (darolutamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
-
Nucala® (mepolizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Nucala® (mepolizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Nuedexta® (dextromethorphan/quinidine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Nuedexta® (dextromethorphan/quinidine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Nuplazid® (pimavanserin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2024
-
Ocaliva® (obeticholic acid) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
-
Ocaliva® (obeticholic acid) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Odomzo® (sonidegib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Ogsiveo™ (nirogacestat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
-
Ojemda™ (tovorafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Ojjaara™ (momelotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.15.2025
-
Olumiant® (baricitinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Olumiant® (baricitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Omnipod® 5 - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Omnipod® 5 - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.27.2024
-
Omvoh™ (mirikizumab-mrkz) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Omvoh™ (mirikizumab-mrkz) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Onureg® (azacitidine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
-
Opfolda™ (miglustat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Ophthalmic Agents - Qlosi (pilocarpine)™ 0.4% ophthalmic solution, Vuity® (pilocarpine) 1.25% ophthalmic solution - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
-
Opioid Supply Limits - Greater than 34 Day Supply for Opioids at Retail
Last Published 06.02.2024
-
Opioid-containing cough medicines - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Opzelura® (ruxolitinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
-
Opzelura® (ruxolitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
-
Oral chemotherapeutic agents - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
-
Orencia® (abatacept) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Orencia® (abatacept) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
-
Orfadin® (nitisinone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Orgovyx™ (relugolix) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Oriahnn® (elagolix and estradiol/norethindrone), MyFembree® (relugolix and estradiol hemihydrate/norethindrone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Orilissa® (elagolix) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Orkambi® (lumacaftor/ivacaftor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Orkambi™ (lumacaftor/ivacaftor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Orladeyo® (berotralstat) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Orladeyo® (berotralstat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Orserdu™ (elacestrant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Osphena® (ospemifene) - Prior Authorization/Notification - UniteHealthcare Commercial Plans
Last Published 06.01.2024
-
Otezla® (apremilast) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Oxervate® (cenegermin-bkbj) ophthalmic solution - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Oxervate® (cenegermin-bkbj) ophthalmic solution - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
PAH Agents - Adcirca® (tadalafil), Adempas® (riociguat), Alyq™ (tadalafil), Letairis® (ambrisentan), Liqrev® (sildenafil) oral suspension, Opsumit® (macitentan), Opsynvi®(macitentan/tadalafil), Orenitram™ (treprostinil), Revatio® (sildenafil citrate) oral powder for suspension, Tadliq® (tadalafil) oral suspension, Tracleer® (bosentan), Tyvaso® (treprostinil), Tyvaso DPI™ (treprostinil), Uptravi® (selexipag), Ventavis® (iloprost) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.15.2024
-
PAH Agents - Adempas® (riociguat), Letairis® (ambrisentan), Liqrev® (sildenafil) oral suspension, Opsumit® (macitentan), Opsynvi® (macitentan/tadalafil), Orenitram™ (treprostinil), Revatio® (sildenafil citrate) oral powder for suspension, Tadliq® oral suspension (tadalafil), Tracleer® (bosentan), Tyvaso® (treprostinil), Tyvaso DPI™ (treprostinil), Uptravi® (selexipag), Ventavis® (iloprost) - Prior Authorizatin/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Palforzia [Peanut (Arachis hypogaea) Allergen Powder-dnfp] - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Palforzia [Peanut (Arachis hypogaea) Allergen Powder-dnfp] - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Palynziq™ (pegvaliase-pqpz) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Palynziq™ (pegvaliase-pqpz) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Pemazyre®(pemigatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Phexxi® (lactic acid, citric acid, and potassium bitartrate) vaginal gel - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Piqray® (alpelisib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Plans with Weight Loss Medication Coverage – phentermine (all brand products including Adipex-P® and Lomaira™), benzphetamine, Contrave® (naltrexone HCl and bupropion HCl, diethylpropion, Imcivree® (setmelanotide), phendimetrazine, orlistat (Xenical®), Qsymia® (phentermine and topiramate extended-release), Saxenda® (liraglutide), Wegovy® (semaglutide) and Zepbound™ (tirzepatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Pomalyst® (pomalidomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Praluent® (alirocumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Praluent® (alirocumab)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Prevymis™ (letermovir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Procysbi® (cysteamine bitartrate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Promacta® (eltrombopag) for oral suspension - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Promacta® - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Pulmozyme® (dornase alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Pyrukynd® (mitapivat) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Pyrukynd® (mitapivat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Qelbree® (viloxazine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
-
Qinlock™ (ripretinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Radicava ORS® (edaravone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Radicava ORS® (edaravone)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.07.2024
-
Relistor® (methylnaltrexone bromide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Repository Corticotropins - Acthar Gel® (Repository corticotropin injection), Purified Cortrophin Gel™ (Repository corticotropin injection USP) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Repository Corticotropins - Acthar Gel® (Repository corticotropin injection), Purified Cortrophin Gel™ (Repository corticotropin injection USP) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Retevmo®(selpercatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Revlimid® (lenalidomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Revuforj® (revumenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2025
-
Reyvow® (lasmiditan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Reyvow® (lasmiditan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Rezdiffra™ (resmetirom) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
-
Rezdiffra™ (resmetirom) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Rezurock® (belumosudil) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.17.2024
-
Rhofade® (oxymetazoline cream) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Rinvoq® (upadacitinib) extended-release tablets/ Rinvoq® LQ (upadacitinib) oral solution - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Rinvoq® (upadacitinib) extended-release tablets/ Rinvoq® LQ (upadacitinib) oral solution - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Rivfloza™ (nedosiran) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
-
Rivfloza™ (nedosiran) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
-
Rozlytrek™ (entrectinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
-
Rubraca® (rucaparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
-
Ruconest® (C1 esterase inhibitor [recombinant]) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
-
Ruconest® (C1 esterase inhibitor [recombinant]) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Rukobia (fostemsavir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.11.2025
-
Rydapt®(midostaurin) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Samsca® (tolvaptan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Sandostatin® (octreotide acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Scemblix® (asciminib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.11.2025
-
Selzentry® (maraviroc) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
-
Sensipar® (cinacalcet) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
-
Short-Acting Opioid Review Criteria for opioid naïve members - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Signifor® (pasireotide diaspartate) - Prior Authorization/Notification - UnitedHealth Commercial Plans
Last Published 12.18.2024
-
Siliq (brodalumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Siliq™ (brodalumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 09.29.2023
-
Simponi® (golimumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Simponi® (golimumab) - Prior Authorization/Notification - UnitedHealthcaare Commercial Plans
Last Published 12.18.2024
-
Single Source Brand Anticonvulsants - Aptiom (eslicarbazepine), Briviact (brivaracetam), Epidiolex (cannabidiol), Fintepla (fenfluramine), Fycompa (perampanel), and Xcopri (cenobamate) and Ztalmy (ganaxolone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 01.07.2025
-
Skyclarys™ (omaveloxolone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Skyclarys™ (omaveloxolone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Skyrizi® (risankizumab-rzaa) injection - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Skyrizi® (risankizumab-rzaa) injection - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Slynd® (drospirenone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.17.2024
-
Sohonos™ (palovarotene) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Sohonos™ (palovarotene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Solaraze (diclofenac 3% gel) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Somavert® (pegvisomant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Somavert® (pegvisomant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Sotyktu™ (deucravacitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Sotyktu™ (deucravacitinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Sovaldi® (sofosbuvir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Sovaldi® (sofosbuvir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Spevigo® (spesolimab-sbzo) injection - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Spevigo® (spesolimab-sbzo) injection - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Spravato® (esketamine) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Spravato™ (esketamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Sprycel® (dasatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Stelara® (ustekinumab), Steqeyma (ustekinumab-stba), Yesintek™ (ustekinumab-kfce) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Stelara® (ustekinumab), Steqeyma (ustekinumab-stba), Yesintek™ (ustekinumab-kfce) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Stendra® (avanafil) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Stivarga® (regorafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Strensiq® (asfotase alfa) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Strensiq™ (asfotase alfa) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Stromectol® (ivermectin) oral dosage form - Prior Authorizatin/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2024
-
Sublingual Immunotherapy (SLIT) - Grastek (Timothy grass pollen allergen extract), Odactra (Dermatophagoides farinae/Dermatophagoides pteronyssinus allergen extract), Oralair (Sweet Vernal, Orchard, Perennial Rye, Timothy, and Kentucky Blue Grass Mixed Pollens allergen extract), Ragwitek (Short Ragweed Pollen allergen extract) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Sublingual Immunotherapy (SLIT) – Grastek (Timothy grass pollen allergen extract), Odactra (Dermatophagoides farinae/Dermatophagoides pteronyssinus allergen extract), Oralair (Sweet Vernal, Orchard, Perennial Rye, Timothy, and Kentucky Blue Grass Mixed Pollens allergen extract), Ragwitek (Short Ragweed Pollen allergen extract) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Suboxone - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2024
-
Sucraid (sacrosidase) oral solution - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
-
Sucraid (sacrosidase) oral solution - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
-
Sunlenca® (lenacapavir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Sunosi® (solriamfetol) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
-
Sunosi® (solriamfetol) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
-
Sutent® (sunitinib malate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Symdeko® (tezacaftor/ivacaftor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Symdeko® (tezacaftor/ivacaftor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Syprine® (trientine hydrochloride), Trientine hydrochloride - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Tabrecta® (capmatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Tafinlar® (dabrafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Tagrisso™ (osimertinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.15.2025
-
Takhzyro® (lanadelumab-flyo) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Takhzyro™ (lanadelumab-flyo) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Taltz (ixekizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Taltz® (ixekizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Talzenna® (talazoparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.01.2024
-
Tarceva® (erlotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Tarpeyo® (budesonide delayed-release capsules) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Tasigna® (nilotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Tasmar® (tolcapone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Tavalisse®(fostamatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
-
Tavneos® (avacopan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
-
Tavneos® (avacopan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
-
Tazorac® (tazarotene) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Tazverik®(tazemetostat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Tegsedi® (inotersen) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Tegsedi® (inotersen) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Temodar® (temozolomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Tepmetko® (tepotinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
-
Testosterone - Androderm®, Androgel®, Fortesta®, Jatenzo®, Natesto®, Kyzatrex™, Testim®, testosterone topical solution (generic Axiron®), testosterone transdermal gel (generic Testim), Tlando™, Undecatrex™, Vogelxo®, Xyosted® - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Tezspire™ (tezepelumab-ekko) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Tezspire™ (tezepelumab-ekko) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Thalomid® (thalidomide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Therapeutic Duplication - Administrative Override - UnitedHealthcare Commercial Plans
Last Published 09.15.2024
-
Tibsovo® (ivosidenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
-
Tobacco Cessation - Varenicline (generic Chantix®), Nicotrol Inhaler® (nicotine inhalation system), and Nicotrol NS® (nicotine nasal spray) - Prior Authorization/Notification - Healthcare Reform - UnitedHealthcare Commercial Plans
Last Published 02.01.2024
-
Tobacco Cessation – New Jersey Fully Insured Varenicline (generic Chantix®), Nicotrol Inhaler® (nicotine inhalation system), and Nicotrol NS® (nicotine nasal spray) - UnitedHealthcare Commercial Plans
Last Published 02.01.2024
-
Tobacco Cessation – Supply Limit (Therapy Duration) Override – Kentucky Fully Insured - Varenicline (generic Chantix®), Nicotrol Inhaler® (nicotine inhalation system), and Nicotrol NS® (nicotine nasal spray) - UnitedHealthcare Commercial Plans
Last Published 02.01.2024
-
Topical Antifungals - Jublia® (efinaconazole) and tavaborole - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Topical Products - NJ & NY - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2024
-
Topical Retinoid Products - Altreno® (tretinoin), Arazlo®, (tazarotene), Avita® (tretinoin), Atralin® (tretinoin), Retin-A® (tretinoin) [brand only], Retin-A Micro® (tretinoin microspheres), Differin® (adapalene), Fabior® (tazarotene), Tazorac® (tazarotene), and Aklief® (trifarotene) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Tremfya® (guselkumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Tremfya® (guselkumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Trikafta® (elexacaftor/tezacaftor/ivacaftor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Trikafta® (elexacaftor/tezacaftor/ivacaftor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Trulance® (plecanatide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Truqap™ (capivasertib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
-
Tryngolza™ (olezarsen) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Tryngolza™ (olezarsen) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Tryvio™ (aprocitentan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
-
Tukysa® (tucatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Turalio® (pexidartinib)- Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Tykerb® (lapatinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Tymlos™ (abaloparatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Upneeq (oxymetazoline) 0.1% ophthalmic solution - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.11.2025
-
Valchlor® gel for topical use (mechlorethamine) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Vanflyta® (quizartinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.17.2024
-
Vascepa® (icosapent ethyl) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Vascepa® (icosapent ethyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Vecamyl® (mecamylamine) - Prior Authorization/Notificataion - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
-
Velsipity™ (etrasimod) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Velsipity™ (etrasimod) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
-
Veltassa® (patiromer) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
-
Vemlidy® (tenofovir alafenamide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Venclexta® (venetoclax) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
-
Veozah™ (fezolinetant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Verkazia® (cyclosporine 0.1% ophthalmic emulsion) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Verquvo® (vericiguat) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.19.2024
-
Verquvo® (vericiguat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
-
Verzenio® (abemaciclib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
-
Viberzi® (eluxadoline) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
-
Vijoice® (alpelisib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Vijoice® (alpelisib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
-
Vitrakvi® (larotrectinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
-
Vivjoa® (oteseconazole) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.05.2024
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Vizimpro® (dacomitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Vonjo (pacritinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Voquezna® (vonoprazan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
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Voranigo® (vorasidenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.11.2025
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Vosevi®(sofosbuvir, velpatasvir, and voxilaprevir) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 11.01.2024
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Vosevi™ (sofosbuvir, velpatasvir, and voxilaprevir) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 11.01.2024
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Votrient® (pazopanib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Vowst (fecal microbiota spores, live-brpk) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.11.2025
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Vowst™ (fecal microbiota spores, live-brpk) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Voxzogo™ (vosoritide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.11.2025
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Voxzogo™ (vosoritide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.11.2025
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Voydeya™ (danicopan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
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Voydeya™ (danicopan) - Prior Authorization/Notification - UniteedHealthcare Commercial Plans
Last Published 08.01.2024
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Vtama® (tapinarof) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.11.2025
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Vtama® (tapinarof) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.11.2025
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Vumerity® (diroximel fumarate) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
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Vyleesi™ (bremelanotide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Vyndaqel® (tafamidis meglumine) and Vyndamax (tafamidis) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
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Vyndaqel® (tafamidis meglumine) and Vyndamax™ (tafamidis) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
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Wainua™ (eplontersen) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Wainua™ (eplontersen) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Wakix® (pitolisant) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
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Wakix® (pitolisant) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
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Wegovy® (semaglutide) - Cardiovascular Risk Reduction Only - Prior Authorization/Non-Formulary - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
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Welireg™ (belzutifan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Winlevi (clascoterone) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Winrevair™ (sotatercept-csrk) - Prior Authorizatin/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
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Winrevair™ (sotatercept-csrk) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
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Xalkori® (crizotinib) - Non-Formulary - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Xdemvy™ (lotilaner) ophthalmic solution 0.25% - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Xeljanz®/Xeljanz® XR/Xeljanz® Oral Solution (tofacitinib) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Xeljanz®/Xeljanz® XR/Xeljanz® Oral Solution (tofacitinib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Xermelo® (telotristat ethyl) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
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Xifaxan® (rifaximin) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.01.2024
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Xolair® (omalizumab) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 07.01.2024
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Xolair®(omalizumab) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
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Xolremdi™ (mavorixafor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 10.15.2024
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Xolremdi™ (mavorixafor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 10.15.2024
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Xphozah® (tenapanor) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
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Xphozah® (tenapanor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
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Xpovio™ (selinexor) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
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Xtandi® (enzalutamide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
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Xuriden® (uridine triacetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.22.2024
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Xyntha® (antihemophilic factor [recombinant]) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.01.2024
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Yorvipath® (palopegteriparatide) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
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Yorvipath® (palopegteriparatide) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.01.2025
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Yupelri® (revefenacin inhalation solution) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.10.2025
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Zejula™ (niraparib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.11.2025
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Zelboraf® (vemurafenib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Zeposia® (ozanimod) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 02.01.2025
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Zeposia® (ozanimod) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.11.2025
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Zilbrysq® (zilucoplan) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
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Zilbrysq® (zilucoplan) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.02.2025
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Zilxi® (minocycline) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 04.01.2024
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Zokinvy™ (lonafarnib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 06.01.2024
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Zolinza® (vorinostat) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Zoryve® (roflumilast) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Zoryve® (roflumilast) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.11.2025
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ZTLido™ - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 02.01.2024
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Zurzuvae® (zuranolone) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 03.11.2025
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Zydelig® (idelalisib) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024
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Zykadia® (ceritinib) - Non-Formulary - UnitedHealthcare Commercial Plans
Last Published 04.22.2025
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Zymfentra (infliximab-dyyb) - Prior Authorization/Medical Necessity - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Zymfentra (infliximab-dyyb) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 12.18.2024
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Zytiga® (abiraterone acetate) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Last Published 08.01.2024