Updates for UnitedHealthcare prior authorizations for bleeding disorder medications and for voluntary requests for pre-determination

Beginning in 2023, Optum — an affiliate company of UnitedHealthcare — will start managing prior authorization requests from providers seeking medical benefit coverage for medications used to treat bleeding disorders, such as Hemlibra® or factor products, for UnitedHealthcare commercial plan members. Providers seeking coverage for members that self-administer medication for their bleeding disorders should contact the member’s pharmacy benefit manager for coverage questions. 

In addition, the process for requesting pre-determination for medications covered under the medical benefit will also move to Optum. A pre-determination is a voluntary request for benefit coverage review for a medication or service that does not require prior authorization.

Requesting prior authorizations or pre-determinations using the Specialty Guidance Program tool in the UnitedHealthcare Provider Portal is designed to reduce the turnaround time for a determination by leveraging auto-decisioning technology that results in over 50%¹ of all prior authorization cases approved in real time. The system will document clinical requirements, as applicable, during the intake process and prompt you to provide responses to the clinical criteria questions.

Learn more about the Specialty Guidance Program.

For questions, please contact your broker or UnitedHealthcare representative.