UnitedHealthcare Prior Authorization Lookup
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Latest UnitedHealthcare prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Alyftrek (vanzacaftor/tezacaftor/deutivacaftor) prior authorizationDefines UnitedHealthcare prior authorization, initial authorization, and reauthorization criteria for Alyftrek for members with cystic fibrosis aged 6 years and older, including required CFTR mutation documentation and duration of authorization.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Alyftrek (vanzacaftor/tezacaftor/deutivacaftor) prior authorizationPrior authorization and medical necessity criteria for Alyftrek for treatment of cystic fibrosis in patients aged 6 years and older; applies to UnitedHealthcare pharmacy benefits and providers requesting coverage.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Ampyra (dalfampridine) prior authorizationDefines UnitedHealthcare prior authorization requirements for Ampyra (dalfampridine) for patients with multiple sclerosis who have difficulty walking; applies to pharmacy benefit management and prescribing providers seeking coverage.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Cholbam (cholic acid) prior authorizationDefines UnitedHealthcare prior authorization and reauthorization criteria for Cholbam (cholic acid) for treatment of bile acid synthesis disorders due to single enzyme defects and as adjunctive therapy for peroxisomal disorders including Zellweger spectrum disorders.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Cognitive Rehabilitation and Coma Stimulation (for Pennsylvania Only)Outpatient cognitive rehabilitation coverage and the medical policy stance on coma stimulation for UnitedHealthcare Community Plan members in Pennsylvania. It governs prior authorization and medical necessity considerations for outpatient services in that state.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (for Pennsylvania Only)Policy governs coverage and medical necessity criteria for continuous glucose monitoring (CGM) and insulin delivery devices for Pennsylvania Medicaid and CHIP members; it directs providers to state-specific handbook and InterQual criteria for detailed prior authorization guidance.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Copiktra (duvelisib) prior authorizationPrior authorization and coverage criteria for Copiktra (duvelisib) for treatment of relapsed/refractory CLL/SLL and certain T-cell lymphomas; applies to UnitedHealthcare pharmacy benefit members and prescribers requesting coverage.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Daybue (trofinetide) prior authorization for Rett syndromeThis policy governs prior authorization and medical necessity criteria for Daybue (trofinetide) for treatment of Rett syndrome in beneficiaries of UnitedHealthcare. It affects prescribers and pharmacies seeking authorization for initial and continued therapy.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Dojolvi (triheptanoin) prior authorizationPrior authorization and medical necessity criteria for Dojolvi (triheptanoin) for treatment of long-chain fatty acid oxidation disorders (LC-FAOD) for UnitedHealthcare members; affects prescribers requesting coverage.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Dojolvi (triheptanoin) prior authorizationDefines prior authorization requirements and coverage criteria for Dojolvi (triheptanoin) for members with long-chain fatty acid oxidation disorders (LC-FAOD). Applies to UnitedHealthcare pharmacy benefit prior authorization processes.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Durable Medical Equipment, Orthotics, Medical Supplies, and Repairs/Replacements (for Pennsylvania Only)Policy governing coverage, medical necessity, coding, and documentation requirements for durable medical equipment (DME), orthotics, and related supplies for UnitedHealthcare members in Pennsylvania; applies to home/outpatient DME requests and directs providers to state-specific prior authorization and bulletin guidance.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Entyvio (vedolizumab) subcutaneous prior authorizationDefines prior authorization and reauthorization criteria for subcutaneous vedolizumab (Entyvio) for adults with moderately to severely active ulcerative colitis or Crohn's disease for UnitedHealthcare members.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Eohilia (budesonide oral suspension) prior authorization — coverage criteria for eosinophilic esophagitisDefines UnitedHealthcare prior authorization and medical necessity criteria for Eohilia (budesonide oral suspension) for treatment of eosinophilic esophagitis (EoE) in patients age 11 and older, including initial and reauthorization requirements and authorization durations.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Joenja (leniolisib) prior authorizationDefines UnitedHealthcare Pharmacy prior authorization and reauthorization requirements for Joenja (leniolisib) for treatment of activated phosphoinositide 3-kinase delta (APDS) in patients 12 years and older.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Joenja (leniolisib) prior authorization for APDSClinical pharmacy prior authorization and medical necessity criteria for use of Joenja (leniolisib) to treat activated PI3Kδ syndrome (APDS) in eligible members aged 12 and older; applies to UnitedHealthcare pharmacy programs.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Maximum Dosage and Frequency (Medical Benefit Drug Policy)Defines maximum dosage and frequency rules for medical-benefit drugs under UnitedHealthcare Commercial and Individual Exchange plans; applies to providers submitting medical benefit drug claims and prior authorization requests.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Mekinist (trametinib) prior authorizationPrior authorization and coverage criteria for Mekinist (trametinib) across FDA‑labeled and selected NCCN‑recommended oncologic indications for UnitedHealthcare members; applies to prescribers requesting coverage for the drug.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Myalept (metreleptin) prior authorization and medical necessityDefines UnitedHealthcare prior authorization and medical necessity criteria for Myalept (metreleptin) use to treat complications of leptin deficiency in patients with congenital or acquired generalized lipodystrophy; applies to clinicians and payers managing coverage decisions.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Myqorzo (aficamten) prior authorization for obstructive hypertrophic cardiomyopathyDefines prior authorization and medical necessity criteria for Myqorzo (aficamten) for adults with symptomatic obstructive hypertrophic cardiomyopathy (oHCM) and related reauthorization rules; applies to UnitedHealthcare pharmacy benefits.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Organ and tissue transplantation servicesDefines UnitedHealthcare coverage, prior authorization, designated facility requirements, and covered vs. not-covered transplant services for members; applies to UnitedHealthcare benefit plans subject to federal/state mandated regulations.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Phexxi / Phexx (lactic acid, citric acid, potassium bitartrate) vaginal gel — Prior Authorization Medical Necessity CriteriaPrior authorization medical necessity criteria for coverage of Phexxi/Phexx vaginal gel as an on‑demand contraceptive for females of reproductive potential; affects providers seeking coverage for this medication under UnitedHealthcare clinical pharmacy programs.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Praluent (alirocumab) prior authorizationPrior authorization and coverage criteria for Praluent (alirocumab) for UnitedHealthcare members, including indications, initial and reauthorization requirements, and combination therapy restrictions.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Private Duty Nursing Services (for Kentucky Only)Policy governing coverage and requirements for Private Duty Nursing (PDN) services for UnitedHealthcare Community Plan members in Kentucky, including criteria for Skilled Care and documentation/prior authorization processes.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Provider Administered Drugs - Site of Care Policy (expanded oncology injectable list)Defines site-of-care medical necessity review and coverage rules for certain provider-administered oncology drugs and who this affects (providers, members, and participating UnitedHealthcare commercial plans). Applies to prior authorization requests for listed injectable oncology medications beginning Aug 1, 2026.All UnitedHealthcare updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Pyrukynd (mitapivat) prior authorizationRules for prior authorization and reauthorization of Pyrukynd (mitapivat) for treatment of hemolytic anemia in adults with pyruvate kinase (PK) deficiency; applicable to UnitedHealthcare pharmacy benefit administration.All UnitedHealthcare updates
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Tool Description
Search UnitedHealthcareprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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