Pa Notification Keveyis Ormalvi
UnitedHealthcare prior authorization/notification program governing coverage of dichlorphenamide (Keveyis and Ormalvi) for treatment of primary hyperkalemic periodic paralysis, primary hypokalemic periodic paralysis, and related variants; includes initial and reauthorization criteria, authorization durations, and notes on exclusions and automated approvals.
Effective date set to 5/1/2026 and program entry noted as 2026 P 1177-11.
Updated initial authorization duration to 12 months (change noted in 2/2025).
Added generic dichlorphenamide and Ormalvi to the program (2/2025).
Added coverage exclusion statement for brand Keveyis and Ormalvi (2/2025).
Annual reviews from 2016–2026 noted; 2/2026 annual review updated references with no coverage criteria changes.
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