UnitedHealthcare Community Plan
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Pharmacy Program

 

Manuals and Training 

Pharmacy Provider Manual (PDF 442.69 KB)

OptumRx Pharmacy Manual is  available on-line at http://learn.optumrx.com/pharmacymanual and should be reviewed in conjunction with UHC TX Pharmacy Provider Manual. 

View additional Provider Training

Children's Health Insurance Program (CHIP)

Pharmacy Program 

 

Pharmacy Prior Authorization Forms

General Pharmacy Prior Authorization Formsl (PDF 52.3 KB)

Pharmacy Bulletins

For important announcements from the Texas Health and Human Services Commission, please go to the Provider Information tab.

Prior Authorization

Standard Prior Authorization Form (PDF 1.04 MB) - Date Posted 06.04.2015


STAR

Pharmacy Program 

 

Preferred Drug List (PDL) Search

Pharmacy Bulletins

For important announcements from the Texas Health and Human Services Commission, please go to the Provider Information tab.

Pharmacy Flu Vaccine and Immunization/Injection Billing Guidelines (PDF 50.17 KB) 

Texas Health Steps (PDF 521.41 KB)

Texas Vitamins and Minerals (PDF 67.06 KB)

Synagis Program (PDF 59.32 KB)

 

Pharmacy Prior Authorization Forms

Standard Prior Authorization Form (PDF 1.04 MB) - posted 5.19.2016

Limited Home Health Supplies (LHHS) 

Texas allows certain supplies (Limited Home Health Supplies or LHHS) that are covered benefits of Texas Medicaid to be provided by a pharmacy benefit. Our network of pharmacies will be allowed to provide a limited set of basic home health supplies to clients enrolled in Medicaid (STAR and STAR+PLUS members).

More information regarding this program, including a list of supplies available through the Texas Medicaid Preferred Drug List (PDL) can be found at https://www.txvendordrug.com/formulary/home-health-supplies and TX Pharmacies May Dispense Limited Home Health Supplies (PDF 35.49 KB)


STAR Kids

Pharmacy Program 

 

Preferred Drug List (PDL) Search

Pharmacy Bulletins

For important announcements from the Texas Health and Human Services Commission, please go to the Provider Information tab.

Texas Health Steps (PDF 521.41 KB)

Important Information for Participating Pharmacies (PDF 744.07 KB)

Synagis Program (PDF 59.32 KB)

Texas Vitamins and Minerals (PDF 67.06 KB)

 

Pharmacy Prior Authorization Forms

Standard Prior Authorization Form (PDF 1.04 MB) - posted 5.19.2016

Limited Home Health Supplies (LHHS) 

Texas allows certain supplies (Limited Home Health Supplies or LHHS) that are covered benefits of Texas Medicaid to be provided by a pharmacy benefit. Our network of pharmacies will be allowed to provide a limited set of basic home health supplies to clients enrolled in Medicaid (STAR and STAR+PLUS members).

More information regarding this program, including a list of supplies available through the Texas Medicaid Preferred Drug List (PDL) can be found at https://www.txvendordrug.com/formulary/home-health-supplies and TX Pharmacies May Dispense Limited Home Health Supplies (PDF 35.49 KB)


STAR+PLUS

Pharmacy Program 

 

Preferred Drug List (PDL) Search

Pharmacy Bulletins

For important announcements from the Texas Health and Human Services Commission, please go to the Provider Information tab.

Texas Health Steps (PDF 521.41 KB)

Synagis Program (PDF 59.32 KB)

Pharmacy Flu Vaccine and Immunization / Injection Billing Guidelines  (PDF 50.17 KB)

Texas Vitamins and Minerals (PDF 67.06 KB)

 

Pharmacy Prior Authorization Forms

Standard Prior Authorization Form (PDF 1.04 MB) - posted 5.19.2016

Texas Vendor Drug Program Clinical Edit Criteria

Implemented Clinical Prior Authorization Criteria/Logic (PDF 47.28 KB)

Texas now allows certain supplies (Limited Home Health Supplies or LHHS) that are covered benefits of Texas Medicaid to be provided by a pharmacy benefit. As of November 12, 2012, our network of pharmacies will be allowed to provide a limited set of basic home health supplies to clients enrolled in Medicaid (STAR and STAR+PLUS members). More
information regarding this program, including a list of supplies available through the Texas Medicaid PDL can be found here: http://www.txvendordrug.com/formulary/limited-hhs.shtml and here: TX Pharmacies May Dispense Limited Home Health Supplies (PDF 35.49 KB)

 

Limited Home Health Supplies (LHHS) 

Texas allows certain supplies (Limited Home Health Supplies or LHHS) that are covered benefits of Texas Medicaid to be provided by a pharmacy benefit. Our network of pharmacies will be allowed to provide a limited set of basic home health supplies to clients enrolled in Medicaid (STAR and STAR+PLUS members).

More information regarding this program, including a list of supplies available through the Texas Medicaid Preferred Drug List (PDL) can be found at https://www.txvendordrug.com/formulary/home-health-supplies and TX Pharmacies May Dispense Limited Home Health Supplies (PDF 35.49 KB)


UnitedHealthcare Connected® (Medicare-Medicaid Plan)


UnitedHealthcare Dual Complete® (HMO SNP)
H4514-001


UnitedHealthcare Dual Complete® (HMO SNP)
H4590-020


UnitedHealthcare Dual Complete® (HMO SNP)
H4590-022


UnitedHealthcare Dual Complete® (HMO SNP)
H5322-025


UnitedHealthcare Dual Complete® (HMO SNP)
H5322-026


UnitedHealthcare Dual Complete® (HMO SNP)
H4590-033


UnitedHealthcare Dual Complete® (PPO SNP)
H2228-041


UnitedHealthcare Dual Complete® Focus (HMO SNP)
H4527-003


UnitedHealthcare Dual Complete® Focus (HMO SNP)
H4527-004


UnitedHealthcare Dual Complete® Focus (HMO SNP)
H4527-006


UnitedHealthcare Dual Complete® Focus (HMO SNP)
H4527-015