UnitedHealthcare Community Plan
You appear to be browsing this site using Internet Explorer 6. This browser is now out of date. For safer, more reliable browsing it is recommended that you upgrade your browser to Firefox, Safari or Internet Explorer 7 or 8.
Shortcut Navigation:
Please select the state where you practice.

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.

Care Improvement Plus Dual Advantage (Regional PPO SNP)


Children's Health Insurance Program (CHIP)

Pharmacy Prior Authorization Forms

General (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) - posted 6.4.2015


STAR

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.

Synagis Program (PDF 59.32 KB)

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

Vitamins and Minerals

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)


STAR Kids

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.

Important Information for Participating Pharmacies (PDF 744.07 KB)

Synagis Program (PDF 59.32 KB)



Vitamins and Minerals

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)


STAR+PLUS

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.


Synagis Program (PDF 59.32 KB)


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

Vitamins and Minerals

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)

 

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)


UnitedHealthcare Connected® (Medicare-Medicaid Plan)


UnitedHealthcare Dual Complete® (HMO SNP)


UnitedHealthcare Dual Complete® (HMO SNP)
H4590-020


UnitedHealthcare Dual Complete® (HMO SNP)
H4590-022


UnitedHealthcare Dual Complete® (HMO SNP)
H4590-033


UnitedHealthcare Dual Complete® (Local PPO SNP)
H2228-041


UnitedHealthcare Dual Complete® Focus (HMO SNP)


UnitedHealthcare Dual Complete® Focus (HMO SNP)


UnitedHealthcare Dual Complete® Focus (HMO SNP)


UnitedHealthcare Dual Complete® Focus (HMO SNP)