UnitedHealthcare Community Plan
• If you need drugs right away, the pharmacist can fill a one-time, five-day supply of the non-PDL drugs.
• If you take the drug on an ongoing basis, the pharmacist can fill a 15-day supply. The pharmacist will have to call UnitedHealthcare Community Plan's pharmacy department for approval.
1. Some covered drugs need prior authorization.
2. Some drugs are called Step Therapy medications. That means you need to try other drugs before
this one. These are covered only after other first-line drugs have been tried and failed.
3. Some drugs may be limited to the amount a person can be prescribed in one month.
4. Sometimes, a different strength or type of medicine is covered, such as tablets or liquid.
If you need other drugs, your doctor must get Prior Authorization from UnitedHealthcare Community Plan. Your doctor has to state how long you have been taking the drug and what other drugs you
- UnitedHealthcare Community Plan is a MCP that certain Ohio Medicaid consumers who are aged, blind or disabled (ABD) can choose to join. Joining a MCP will not cause you to lose your Medicaid, WIC (Women, Infants and Children) or other public assistance benefits. Joining UnitedHealthcare Community Plan is voluntary. It is your choice.
- You also must live in a county that has UnitedHealthcare Community Plan.
Exclusions – Individuals that are not permitted to join a MCP
Aged, Blind or Disabled (ABD) individuals are not permitted to join a MCP if they are:
- - Children under twenty-one years of age;
- - Dually eligible under both the Medicaid and Medicare programs;
- - Institutionalized;
- - Eligible for Medicaid by spending down their income or resources to a level that meets the Medicaid program's financial eligibility requirements; or
- - Receiving Medicaid Waiver services.
- Additionally, if anyone is a member of a federally recognized Indian tribe they have the option to not be a member of a managed care plan.
- If you believe that you meet any of the above criteria and should not be a member of a managed care plan, or are a member of a federally recognized Indian tribe and do not want to be a member, you must call the Ohio Department of Job and Family Services (ODJFS) Managed Care Enrollment Center at 1-800-605-3040 (TTY 1-800-292-3572).
If you have a medical emergency:
- Get medical help as quickly as possible. Go to the nearest hospital emergency room or other appropriate setting. Be sure to tell them you are a member of UnitedHealthcare Community Plan and show them your ID card if you are able.
- If you need emergency transportation, call 911 or your local emergency service.
- Make sure that your PCP knows about your emergency, because your PCP needs to be involved in following up on your emergency care. You or someone else should call to tell your PCP about your emergency care as soon as possible.
- Emergency services
- Federally Qualified Health Centers / Rural Health Clinics
- Qualified Family Planning Providers
- Community Mental Health Centers
- Ohio Department of Alcohol and Drug Addiction Services facilities that are Medicaid providers
- An out of panel provider that UnitedHealthcare Community Plan has approved you to see
- Pharmacies for prescription drugs and some prescription medical supplies that are covered by Ohio Medicaid