Daa Pangenotypic Mavyret denied as duplicate or overlapping therapy by UnitedHealthcare?

UnitedHealthcare's specific coverage criteria for daa pangenotypic mavyret are defined in its own published medical/coverage policy and the FDA-approved prescribing label. A successful appeal documents that your medical records satisfy each criterion those sources list — confirmed diagnosis, any required prior treatments (with dates and outcomes), and clinical severity. If the exact criteria weren't included with your denial, request them in writing; your appeal then maps each requirement to the matching fact in your chart.

## Why UnitedHealthcare Issues a Duplicate-Therapy Denial for Mavyret

A duplicate-therapy denial from UnitedHealthcare (UHC) typically means UHC's system has identified another active hepatitis C medication on the member's claim or pharmacy profile. This can occur in several scenarios: a prior DAA prescription was not formally discontinued in UHC's records before Mavyret was prescribed; a bridge regimen or combination protocol was coded in a way that appears duplicative; or a data-feed lag created a false overlap between an ended regimen and the new prescription.

In nearly every case, this denial reflects a data or coordination-of-care problem rather than a genuine clinical error by the prescriber.

## Why This Denial Is Appealable

A duplicate-therapy denial cannot be sustained if there is no actual concurrent use of two hepatitis C DAA regimens. Once the prescriber documents that the prior therapy has concluded and Mavyret is the sole active HCV regimen, UHC has no clinical basis to maintain the denial.

## Federal Appeal Framework

• ACA §2719 / ERISA §503: Duplicate-therapy denials are subject to full-and-fair internal appeal and independent external review.
• Timeline: Internal appeal must generally be filed within 180 days of the denial notice. External review must generally be requested within 4 months of an internal denial.
• Expedited option: Available within 72 hours if delay would seriously jeopardize health.

## The Appeal Process

1. Request from UHC the exact duplicate-therapy code and identify which prior drug or claim UHC flagged as the duplicate. 2. Obtain documentation from the pharmacy or prescriber confirming the prior drug was discontinued, including the last fill date. 3. Have the prescriber submit a letter confirming Mavyret is the sole active HCV treatment and explaining why the prior regimen ended. 4. Contact UHC's pharmacy clinical line and the prescriber's prior-authorization team to correct the pharmacy record and resubmit the PA if needed. 5. If the internal appeal is denied, escalate to independent external review.

## Documentation to Gather

• Pharmacy fill history: Records showing the last fill date of any prior HCV drug and confirming no overlapping supply.
• Prescriber letter: States that the prior HCV regimen has been discontinued, states the discontinuation date and reason, and confirms Mavyret is the sole current HCV treatment.
• Discontinuation note: A chart note or medication reconciliation record documenting the end of the prior therapy.
• Active medication list: Current medication list from the medical record showing no other active HCV DAA.

## Criteria-Mapping Structure

Build a two-column table: left column lists each basis UHC cited for the duplicate-therapy finding; right column provides the specific document, date, and source refuting each basis. The goal is to show a clean, non-overlapping treatment timeline with a documented gap — or an intentional transition — between the prior regimen and Mavyret.