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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

Louisiana Independent Pharmacies Association at 

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


Preferred Drug List and Updates

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by Community Plan of Louisiana.

Click on the link below to view the Preferred Drug List.

Preferred Drug List (PDL) Search
Preferred Drug List (PDF 1.32 MB) 
Healthy Louisiana Common PDL (PDF 433.6 KB)

1/1/2018 PDL Update (PDF 63.25 KB)
10/1/2017 PDL Update (PDF 58.95 KB)
7/1/2017 PDL Update (PDF 129.16 KB)
4/1/2017 PDL Update (PDF 63.29 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 Program

Step Therapy Policy (PDF 21.02 KB)


Drug Quantity Limit Initiatives

Quantity Limit Policy (PDF 20.11 KB)

Pharmacy Bulletins  

ADHD and Medication: What You Should Know to Get the Best Results (PDF 141.39 KB)
Louisiana Practitioner Bulletin Q4 2015 Update
(PDF 61.62 KB)
Synagis Enrollment Form (PDF 225.02 KB)  
Synagis Program 
(PDF 53.22 KB)
Synagis Program 5 Doses (PDF 42.79 KB)


Pharmacy Prior Authorization Forms

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


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

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

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.

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



BioScrip (offers nursing services)

also a National Home Infusion Provider for Medical Benefit medications


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


Walgreens Infusion Services (offers nursing services)

Cardiovascular/Heart Failure

Enzyme Deficiency

Gaucher's Disease


Immune Globulin



CVS Caremark Specialty Pharmacy

Enzyme Deficiency

Gaucher's Disease


Pulmonary Hypertension


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).


2018 Pharmacy & Therapeutics Committee Meetings

Wednesday, January 10, 2018
5:00-6:30 p.m. Central Time