UnitedHealthcare Community Plan
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UnitedHealthcare Community Plan

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)

• 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

888-296-4513

 

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 Bulletins

Synagis Enrollment Form (PDF 245.92 KB)  
Synagis Program 
(PDF 52.46 KB)
Synagis Program 5 Doses (PDF 51.26 KB)


Prior Authorization and Medical Exception Forms
Abilify (Atypical Antipsychotic - 24 Hour - Urgent) (PDF 55.62 KB)
Acthar Gel (PDF 56.9 KB)
Advair/Dulera/Symbicort (PDF 61.8 KB)
Ampyra (PDF 57.82 KB)
Aranesp Epogen Procrit (PDF 164.88 KB)
Aranesp Epogen Procrit - Urgent (PDF 154.72 KB)
Celebrex (PDF 63.28 KB)
Compound Medications - 24 Hour Urgent (PDF 76.86 KB)
Effient (PDF 46.2 KB)
Elidel Protopic (PDF 54.09 KB)
Fenofibrate (PDF 55.7 KB)
Forteo (PDF 106.46 KB)
Growth Hormone (PDF 167.93 KB)
Growth Hormone - Urgent (PDF 166.94 KB)
Hepatitis C (PDF 135.06 KB)
Increlex (PDF 69.23 KB)
Itraconazole (PDF 82.75 KB)
Januvia, Janumet, and Janumet XR - Urgent (PDF 99.7 KB)
Kuvan (PDF 56.37 KB)
Long-Acting Opiates (PDF 63.04 KB)
Lovaza (PDF 56.24 KB)
Lovenox (PDF 85.29 KB)
Lupron (PDF 178.62 KB)
Multaq (PDF 75.78 KB)
Onglyza, Kombiglyze XR, Tradjenta, Jentadueto - Urgent (PDF 51.96 KB)
Oral Chemo (PDF 72.85 KB)
Prior Authorization Request Form (PDF 85.31 KB)
Prior Authorization Request Form - Urgent (PDF 85.46 KB)
Promacta (PDF 65.36 KB)
Proton Pump Inhibitors (PDF 61.58 KB)
Renvela (PDF 53.33 KB)
Sensipar (PDF 45.17 KB)
Singulair (PDF 61.87 KB)
Soriatane (PDF 64.33 KB)
Specialty Medication Prior Authorization Cover Sheet (PDF 21.44 KB)
Suboxone (PDF 81.96 KB)
Symlin (PDF 54.29 KB)
Synagis (PDF 245.92 KB)
Testosterone (PDF 97.34 KB)
Topical NSAIDs (PDF 55.45 KB)
TZDs and DPP-4 (PDF 62.6 KB)
Uloric (PDF 55.33 KB)
VFend (PDF 53.31 KB)
Xenazine (PDF 67.28 KB)
Xifaxin (PDF 51.05 KB)
Xolair (PDF 57.61 KB)
Zetia (PDF 57.92 KB)
Zyvox (PDF 47.87 KB)


UnitedHealthcare Connected® for MyCare Ohio

Preferred Drug List (PDL) Search

Download the Acrobat version of the Preferred Drug List (PDL)


UnitedHealthcare Dual Complete™ (HMO SNP)

Preferred Drug List (PDL) Search

Download (PDF 1.04 MB) the Acrobat version of the Preferred Drug List (PDL)

Submit a Pharmacy Prior Authorization Request to Prescription Solutions.

Request for Medicare Prescription Drug Determination Request form