UnitedHealthcare Community Plan
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Community Plan of Louisiana 

Louisiana State of Emergency Notice for Pharmacy Providers


LOUISIANA: STATE OF EMERGENCY DUE TO HEAVY RAIN AND FLOODING

 

UnitedHealthcare Community Plan is responding to the needs of our members and care providers during this State of Emergency with the following Parishes under a State of Emergency:

 

Acadia, Allen, Ascension, Assumption, Avoyelles, Beauregard, Cameron, Calcasieu, East Baton Rouge, East Feliciana, Evangeline, Iberia, Iberville, Jefferson Davis, Lafayette, Livingston, Point Coupee, St. Charles, St. Helena, St. James, St. John, St. Landry, St. Martin, Tangipahoa, Vernon, St. Tammany, Vermilion, Washington, West Baton Rouge, and West Feliciana.

 

UnitedHealthcare Community Plan of Louisiana has lifted the following pharmacy requirements for the Parishes listed above for dates of service from Aug. 13, 2016 until Sept. 12, 2016: 

 

  • Prescription co-payments are being waived.

  • Refill Too Soon rejections are being automatically bypassed.

  • Prior Authorization requirements are being relaxed for many drug categories except controlled substances.  If a retail pharmacy receives a message stating a Prior Auth is required, please contact the OptumRx at 1-866-328-3108

  • Members filling prescriptions out of state can have their prescription filled at any in-network pharmacy, such as CVS, Rite-Aid, Walgreens, or Walmart.

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: Healthcare Ready.org

Louisiana Independent Pharmacies Association at: lipanow.org 


For additional pharmacy information please contact customer services at: 866-675-1607

 

Preferred Drug List (PDL) Search
Preferred Drug List (PDF 949.27 KB) 
Healthy Louisiana Common PDL (PDF 444.8 KB)

10/1/2016 PDL Update  (PDF 69.14 KB)
8/1/2016 PDL Update (PDF 67.71 KB)
5/1/2016 PDL Update (PDF 62.88 KB)
1/1/2016 PDL Update (PDF 56.25 KB)

UnitedHealthcare accepts a standard single page prior authorization form for outpatient pharmacy services.  To access this form, please click here, this form is a complement to UnitedHealthcare's existing prior authorization processes, which providers may continue to use.


Important Step Therapy Information
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 113.79 KB)  
Synagis Program 
(PDF 53.22 KB)
Synagis Program 5 Doses (PDF 42.79 KB)


Pharmacy Prior Authorization Forms

Re-Review Reconsideration Request Form (PDF 158.04 KB)

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: https://www.optumrx.com/RxsolHcpWeb/cmsContent.do?pageUrl=/HCP/LA_MAC_PRICING

MAC appeal form (PDF 65.35 KB)

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. 

 

Pharmacy and Therapeutics Committee:

2016 Committee meeting dates:

• Monday, October 3, 2016 - 5:00pm Central Time

Louisiana P&T Tentative Agenda – 10.3.2016 (PDF 190.49 KB)

 

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).

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.

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.