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Pharmacy Program

 

Opioid Program and Resources

In response to the U.S. opioid epidemic, UnitedHealthcare has developed programs to help our members receive the care and treatment they need safely and effectively.

We’ve also established measures based on the Centers for Disease Control and Prevention’s (CDC) opioid treatment guidelines to help prevent overuse of short-acting and long-acting opioid medications.

Resources from UnitedHealthcare and Optum

Medicated Assisted Treatment: Locate a Provider (PDF 84.58 KB)
Naloxone Coverage for UnitedHealthcare Members
(PDF 323.61 KB)
Naloxone: What You Need to Know
(PDF 62.67 KB)
Opioid Tapering Recommendations
(PDF 102.65 KB)
The Role of Dentists in Managing Opioids
(PDF 448.16 KB)
Treatment Alternatives for Common Pain Conditions 
(PDF 96.61 KB)


Other Resources

Agency for Healthcare Research and Quality (AHRQ)
Interagency Guideline on Prescribing Opioids for Pain

Centers for Disease Control and Prevention (CDC)
CDC Guideline for Prescribing Opioids for Chronic Pain (2016)
CDC Opioid Overdose Guideline Resources

Substance Abuse and Mental Health Services Administration (SAMHSA)
The Role of Prevention in Addressing Neonatal Abstinence Syndrome

 

UnitedHealthcare Community Plan - KanCare

Pharmacy Program


For KanCare pharmacy network contracting questions, please contact: pharmacycontracts@optum.com.
 

Preferred Drug List 

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by KanCare. Click on the link below to view the Preferred Drug List.

Kansas Preferred Drug List

Preferred Drug List (PDL) Search

Quick Reference Guide for the State Preferred Drug List Policies (PDF 101.76 KB)

Phamacy Forms

New KanCare Universal Pharmacy/Medical Prior Authorization Form

KanCare now offers a Universal Pharmacy/Medical Prior Authorization Form. The universal form is intended to simplify the prior authorization process by unifying health plan and Fee-For-Service forms. All forms for all drugs requiring prior approval for all KanCare members will now be located on the Kansas Department of Health and Environment website at http://www.kdheks.gov/hcf/pharmacy/default.htm

This form can be used for any drug prior authorization request. It’s important to review drug criteria and complete the form with all relevant information. If the information required in the specific drug criteria is not included in the prior authorization request, the request may be denied for lack of information.

The form provides all contact information for all KanCare health plans and FFS Pharmacy and Medical Prior Authorization Departments.

Please fax forms to the Pharmacy or Medical Prior Authorization department based on where the drugs are being billed and dispensed:

  • Pharmacy Prior Authorization - Drug dispensed from a pharmacy
  • Medical Prior Authorization - Drug dispensed from a provider office, hospital, or outpatient stock

The KanCare Universal Pharmacy/Medical Prior Authorization Form is available at kdheks.gov/hcf/pharmacy/default.htm.

 

Coordination of Benefits and Billing Instructions - Payer Sheets

Medication Therapy Management (MTM) Program Information

 

Synagis

Synagis Enrollment Form (PDF 119.62 KB)
Synagis Prior Authorization (PDF 77.37 KB)

 

Medicare Part D Copayment Assistance Update for CY 2018

For dates of service on and after Jan. 1, 2018, the Medicare Part D Copayment assistance amount will be $8.35 per 30-day supply with a maximum of up to $25.05 for a 90-day supply.

 

Prior Authorization 

Prior authorization is required for some medications.

View the list of medications that require prior authorization.

 

KanCare 90-Day Supply Maintenance Medication Policy

View the KanCare 90-Day Supply Maintenance Medication Policy (PDF 80.41 KB)

 

Preferred Diabetic Supplies: Test Strip and Meter

Changes Effective Jan. 1, 2016

Effective Jan. 1, 2016, only LifeScan (OneTouch®) meters and test strips will continue to be included on the Preferred Drug List (PDL). The LifeScan meters will be offered at no cost for members. The other manufacturers of tests strips, including Roche (Accu-Chek®), will be removed from the Preferred Drug List and become non-preferred. 

  Preferred Testing Supplies as of January 1, 2016

 

 

One-Touch Meters:

  • OneTouch UltraMini Meter
  • OneTouch Ultra 2 Meter
  • OneTouch Verio Meter
  • OneTouch Verio IQ Meter
  • OneTouch Verio Sync Meter

 

 

One-Touch Test Strips:

  • OneTouch Ultra Test Strips
  • OneTouch Verio Test strips

Please encourage your patients to use the preferred products and provide them with a new prescription for these products. If the preferred alternative testing supplies are not appropriate for your patients, they may still obtain the non-preferred brand through a DME provider and you will not need to do anything different to keep your patient on the non-preferred product.

If you have questions, please call Provider Services at 877-542-9235, Monday – Friday, 8 a.m. to 8 p.m. (CT). Thank you.

 

Maximum Allowable Cost List Administration


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. Sources include de-identified market pricing, benchmark data including Average Wholesale Price (AWP) and Wholesaler Acquisition Cost (WAC), wholesaler information on market availability, and individual pharmacy feedback.

The synthesis of this information helps create a market based MAC price for generic items included on the MAC list. These sources are monitored and updates are used to help manage the market fluctuations of pricing on the MAC list.
The MAC lists are reviewed on a monthly basis.

For Kansas Medicaid MAC inquiries, please contact OptumRx through email at medicaid_macappeal@optum.com. For general
contract information, please contact OptumRx at 1-800-613-3591 option 7 or through email at pharmacycontracts@optum.com.

 

 

MAC Price Lookup

A contracted pharmacy may access MAC prices here: https://professionals.optumrx.com/landing/kansas.html 


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

MAC Appeal Form (PDF 271.25 KB)

MAC Appeal Submission Guide

 


UnitedHealthcare Dual Complete® (HMO-POS SNP)
H5322-029