UnitedHealthcare Community Plan
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Pharmacy Program

 

Community Plan of Louisiana 

 

Assistance with Locating a Pharmacy

Providers who would like to assist their UnitedHealthcare Community Plan patients with finding nearby open pharmacies in areas impacted by disaster, please refer to the following organizations. 

Healthcare Ready at HealthcareReady.org

Louisiana Independent Pharmacies Association at lipanow.org 

For additional pharmacy information, contact customer service at 866-675-1607.

 

Preferred Drug Lists 

Preferred Drug List (PDL) Search
Preferred Drug List (PDF 1.32 MB) 
Healthy Louisiana Common PDL (PDF 429.92 KB)

7/1/2017 PDL Update (PDF 129.16 KB)
4/1/2017 PDL Update (PDF 63.29 KB)
1/1/2017 PDL Update (PDF 157.62 KB)
10/1/2016 PDL Update (PDF 69.14 KB)

UnitedHealthcare accepts a standard single page prior authorization form for outpatient pharmacy services as a complement to our existing prior authorization processes. Use the single page Prior Authorization Form.


Step Therapy

Step Therapy Policy (PDF 21.02 KB)

 

Quantity Limit Initiatives 

Quantity Limit Policy (PDF 20.11 KB)


Pharmacy Bulletins  

Louisiana Practitioner Bulletin Q4 2015 Update (PDF 61.62 KB)
Synagis Enrollment Form (PDF 511.58 KB)  
Synagis Program 
(PDF 53.22 KB)
Synagis Program 5 Doses (PDF 42.79 KB)


Pharmacy Prior Authorization Forms

 

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 Louisiana Medicaid MAC inquiries, please contact OptumRx through email at RxReimbursement@Optum.com.

MAC Price Lookup
A contracted pharmacy may access MAC prices here.

MAC Appeal Form (PDF 65.35 KB)
MAC Appeal Submission Guide

For general contract information, please contact OptumRx at 1-800-797-9798.

Pharmacies with specific claim related questions should contact OptumRx at 1-866-328-3108. 

 

Medical Injectables

Click the arrow above to view the medical injectable information. 

Specialty pharmacy medications covered on the Medical Benefit may be provided through a variety of channels – home infusion provider, outpatient facility, physician, or specialty pharmacy.

For physicians who do not want to buy-and-bill a specialty pharmacy medication that is covered on the Medical Benefit, they may choose to source it through a network specialty pharmacy:

Network Specialty Pharmacy

Phone Number

OptumRx

866-218-7398

BioScrip (offers nursing services)

 v also a National Home Infusion Provider for Medical Benefit medications

866-788-7710

The following specialty pharmacies may also provide specific categories of specialty pharmacy medications:

Network Specialty Pharmacy

Medication Category

Phone Number

Accredo (offers nursing services)

Enzyme Deficiency

Gaucher’s Disease

Immune Globulin

Pulmonary Hypertension

800-803-2523

Walgreens Infusion Services (offers nursing services)

Cardiovascular/Heart Failure

Enzyme Deficiency

Gaucher’s Disease

Hemophilia

Immune Globulin

Makena

866-827-8203

CVS Caremark Specialty Pharmacy

Enzyme Deficiency

Gaucher’s Disease

Makena

Pulmonary Hypertension

800-237-2767

Coverage of the requested drug is dependent on the member’s benefits, and the availability of a specific drug from a network specialty pharmacy may vary.

The Specialty Pharmacy can deliver the medication to the healthcare practitioner’s office or another site (ex. patient’s home) upon request, and the Specialty Pharmacy will bill the patient’s health plan directly.

 

Pharmacy and Therapeutics Committee

If you are interested in speaking at a committee meeting, please refer to the following document Pharmacy and Therapeutics Committee Speaker Request Form (PDF 77.92 KB).

 

2017 Pharmacy & Therapeutics Committee Meetings

Tuesday, June 27, 2017 from 5:00 p.m. - 6:30 p.m. Central Time
Louisiana Pharmacy & Therapeutics Tentative Meeting Agenda (PDF 52.18 KB)