UnitedHealthcare Community Plan
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UnitedHealthcare Community Plan - KanCare

Pharmacy Program

For KanCare pharmacy network contracting questions, please contact: pharmacycontracts@optum.com.

Preferred Drug List 

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by KanCare. Click on the link below to view the Preferred Drug List.

Kansas Preferred Drug List

Preferred Drug List (PDL) Search


Pharmacy Forms 

Coordination of Benefits Billing Instructions (PDF 47.25 KB)

Medication Therapy Management (MTM) Program Information 

Prior Authorization Form (PDF 66.82 KB)

Online Prior Authorization Submission (PDF 20.96 KB)

Quantity Limit Policy (PDF 20.96 KB) 

Re-Review / Reconsideration Prior Authorization Request Form (PDF 95.03 KB) (PDF 263.25 KB)

UHC KanCare Pharmacy Contact List (PDF 263.25 KB)

UHC Flu Vaccine Information 2015-2016 (PDF 86.08 KB)


Medicare Part D Copayment Assistance Update for CY 2017

For dates of service on and after Jan. 1, 2017, the Medicare Part D Copayment assistance amount will be $8.25 per 30-day supply with a maximum of up to $24.75 for a 90-day supply. 


KANCARE 90-Day Supply Maintenance Medication Policy

The Kansas Department of Health and Environment requires a mandatory 90-day fill policy to be implemented for maintenance medications for all KanCare managed care beneficiaries.

90-Day Maintenance Medication List (PDF 231.66 KB) 

View 90-Day Supply Maintenance Medication Requirements and Exclusions

Click on the arrow above to view the 90-day supply maintenance medication policy requirements and exclusions.

Requirements for prescriptions that should be converted to 90-day supplies are as follows:

  • Medication is included in the specific drug list for 90-day supplies designated by the state.
  • Patient has had consecutive fills of the medication, resulting in at least 90 days of dispensing within the previous 365 day period
  • Day 1 of the look-back period will be July 15, 2016 and patients must have had at least 90 days of dispensing after this date to be transitioned to the mandatory 90-day fill for maintenance medications.
  • Beneficiaries will have the option of 90 day fills starting April 1, 2016, for medications listed on the attached 90-day supply list and 90 day fills will become mandatory on July 15, 2016.

Patients receiving prescription medications covered under this policy will be notified of the new requirement for the 90 day supply.

The following populations will be excluded from the 90-day fill requirement:

  • Beneficiaries identified as members of the foster care population.
  • Beneficiaries designated as Medically Needy with a spenddown.
  • Beneficiaries residing in long term care facilities; Beneficiaries receiving the hospice benefit.
  • Beneficiaries with other primary prescription insurance (TPL), when prohibited by primary prescription insurance. 



Synagis Enrollment Form (PDF 549.6 KB)
Synagis Program
(PDF 64.84 KB)
Synagis Program 5 Doses
(PDF 59.44 KB)
Synagis Prior Authorization
(PDF 66.29 KB)


Prior Authorization 

Prior authorization is required for some medications. The following medications require prior authorization as of 6/10/2015.

Medications Requiring Prior Authorization as of 6/10/2015

Click on the arrow above to view the list. 

Aralast NP
Contrave ER
Prolastin C
Testosterone Powder
Viekira Pak


Pharmacy Prior Authorization Forms

Prior authorization is required for some services and medications. A current list of prior authorization services and forms can be found below.

Refer to the KDHE Pharmacy website for clinical prior authorizations criteria:  http://www.kdheks.gov/hcf/pharmacy/pa_criteria.htm

Pharmacy Prior Authorization Forms

Click on the arrow above to view the pharmacy prior authorization forms.


Pharmacy Benefit Program Updates

Dose Optimization Program (PDF 62.25 KB)


Preferred Diabetic Test Strip and Meter

Changes Effective Jan. 1, 2016

Effective Jan. 1, 2016, only LifeScan (OneTouch®) meters and test strips will continue to be preferred on the Preferred Drug List. The LifeScan meters will be offered at no cost for members. The other manufacturers of tests strips, including Roche (Accu-Chek®), will be removed from the Preferred Drug List and become non-preferred.

Non-Preferred Testing Supplies as of

January 1, 2016

Preferred Testing Supplies as of

January 1, 2016

Accu-Chek Meters:

·      Accu-Chek Aviva Plus

·      Accu-Chek Aviva Connect

·      Accu-Chek Aviva Expert

·      Accu-Chek Compact Plus

One-Touch Meters:

·         OneTouch UltraMini Meter

·         OneTouch Ultra 2 Meter

·         OneTouch Verio Meter

·         OneTouch Verio IQ Meter

·         OneTouch Verio Sync Meter

Accu-Chek Test Strips:

·      Accu-Chek Aviva Plus Test Strips

·      Accu-Chek SmartView Test Strips

·      Accu-Chek Compact Test Strips

·      Accu-Chek Comfort Test Strips

·      Accu-Chek Active Test Strips

One-Touch Test Strips:

·         OneTouch Ultra Test Strips

·         OneTouch Verio Test strips

Please encourage your patients to use the preferred products and provide them with a new prescription for these products. If the preferred alternative testing supplies are not appropriate for your patients, they may still obtain the non-preferred brand through a DME provider and you will not need to do anything different to keep your patient on the non-preferred product.

If you have questions, please call Provider Services at 877-542-9235, Monday – Friday, 8 a.m. to 8 p.m. (CT). Thank you.


Maximum Allowable Cost List Administration

UnitedHealthcare Community Plan works with OptumRx to manage the Pharmacy network. Multiple sources are used by OptumRx in order to assure the Maximum Allowable Cost (MAC) list accurately reflects market pricing and availability of generic drugs. Sources include de-identified market pricing, benchmark data including Average Wholesale Price (AWP) and Wholesaler Acquisition Cost (WAC), wholesaler information on market availability, and individual pharmacy feedback.

The synthesis of this information helps create a market based MAC price for generic items included on the MAC list. These sources are monitored and updates are used to help manage the market fluctuations of pricing on the MAC list.
The MAC lists are reviewed on a monthly basis.

For Kansas Medicaid MAC inquiries, please contact OptumRx through email at medicaid_macappeal@optum.com. For general
contract information, please contact OptumRx at 1-800-613-3591 option 7 or through email at


MAC Price Lookup

A contracted pharmacy may access MAC prices here: https://professionals.optumrx.com/landing/kansas.html 

Pharmacies with specific claim related questions should contact OptumRx at 1-877-305-8952, Available 24 hours daily, 7 days a week.

MAC Appeal Form (PDF 271.25 KB) (PDF 271.25 KB)

MAC Appeal Submission Guide


UnitedHealthcare Dual Complete® (HMO-POS SNP)