UnitedHealthcare Community Plan
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Pharmacy Program 

 

On Jan. 1, 2017, UnitedHealthcare Community Plan of Nebraska began serving Heritage Health members. To avoid disruption of care, we honored previously approved prescription medication authorizations for the first 90 days. The 90-day transition of care period for pharmaceuticals ended on April 1, so care providers may need to submit prior authorization requests and renewals.

To learn more about pharmacy benefit coverage: 
Member Pharmacy Benefit Coverage – Effective Jan. 1, 2017 (PDF 134.66 KB)

 

Other Pharmacy Benefit Resources

Medicaid Pharmacy Benefit Frequently Asked Questions (PDF 246.66 KB)

Pharmacy Program Overview (PDF 745.74 KB) 

 

State of Nebraska Preferred Drug List

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by the Nebraska Department of Medicaid. View the PDL as produced by the state of Nebraska:

Nebraska Preferred Drug List

UnitedHealthcare Preferred Drug List (PDF 1.95 MB)

Pharmacy Preferred Drug List (PDL) Lookup Tool

 

Pharmacy Providers Dispensing Durable Medical Equipment (DME)

 If you would like to be contracted for DME services offered to UnitedHealthcare Community Plan - Heritage Health members, contact Sr. Network Account Manager Angela Hogan at: 

Email : Angela_hogan@uhc.com
Phone: 952-406-4955
Toll Free:  800-284-0626
Fax:  888-868-5011

 


UnitedHealthcare Community Plan - Heritage Health

Pharmacy Program 


Pharmacy Bulletins

Synagis Enrollment Form (PDF 511.58 KB)  
Synagis Program (PDF 58.92 KB) 
Synagis Program 5 Doses (PDF 51.26 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.

Pharmacy Prior Authorization Forms

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

Nebraska General Prior Authorization Request Form (PDF 136.7 KB)

 

Specialty Pharmacy Medications

Prior authorization is required for some services and medications.

Click the arrow below to view a current list of services and information on how to request an authorization.

Specialty Pharmacy Medications
Specialty Pharmacy Medications
Specialty Pharmacy Medications
Medical Injectables

Click on the arrow above to view 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 through a network specialty pharmacy:

Network Specialty Pharmacy

Phone Number

BioScrip (offers nursing services)

• 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

Option Care (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 Contact Information

 

Rx Claims Processing Technical Assistance: Contact the OptumRx Help Desk at
877-231-0131, 24 hours a day, 7 days a week.

Pharmacy Prior Authorization Assistance: Contact our Pharmacy Prior Authorization line at 800-310-6826.

Medical DME Questions: Contact our Provider Service Center at 866-331-2243.

 

MAC Price Lookup and Appeals

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.

Nebraska MAC Price Lookup

MAC Appeal Submission Guide

 

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