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Pharmacy Program

Community Plan of Louisiana 

 

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

 

Assistance with Locating a Pharmacy

Providers who would like to assist their UnitedHealthcare Community Plan patients with finding nearby open pharmacies in areas impacted by disaster, please refer to the following organizations. 

Healthcare Ready at HealthcareReady.org

Louisiana Independent Pharmacies Association at lipanow.org

For additional pharmacy information, contact customer service at 866-675-1607.

 

Preferred Drug List and Updates

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by Community Plan of Louisiana.

Click on the link below to view the Preferred Drug List.

Preferred Drug List (PDL) Search
Preferred Drug List (PDF 1.07 MB) 
Healthy Louisiana Common PDL (PDF 433.6 KB)

1/1/2018 PDL Update (PDF 63.25 KB)
10/1/2017 PDL Update (PDF 58.95 KB)
7/1/2017 PDL Update (PDF 129.16 KB)
4/1/2017 PDL Update (PDF 63.29 KB)

 

UnitedHealthcare accepts a standard single page prior authorization form for outpatient pharmacy services as a complement to our existing prior authorization processes. Use the single page Prior Authorization Form.

 

Step Therapy Program

Step Therapy Policy (PDF 21.02 KB)

 

Drug Quantity Limit Initiatives

Quantity Limit Policy (PDF 20.11 KB)


Pharmacy Bulletins  

ADHD and Medication: What You Should Know to Get the Best Results (PDF 141.39 KB)
Louisiana Practitioner Bulletin Q4 2015 Update
(PDF 61.62 KB)
Synagis Enrollment Form (PDF 225.02 KB)  
Synagis Program 
(PDF 53.22 KB)
Synagis Program 5 Doses (PDF 42.79 KB)

 

Pharmacy Prior Authorization Forms

Prior authorization is required for some services and medications. A current list of prior authorization services, medications and forms can be found below.

 

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 Louisiana Medicaid MAC inquiries, please contact OptumRx through email at RxReimbursement@Optum.com.

MAC Price Lookup

A contracted pharmacy may access MAC prices here.

MAC Appeal Form (PDF 65.35 KB)
MAC Appeal Submission Guide

For general contract information, please contact OptumRx at 1-800-797-9798.

Pharmacies with specific claim related questions should contact OptumRx at 1-866-328-3108. 

 

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.

Specialty pharmacy medications covered under the member’s medical benefit may be obtained through various sources ‒ home infusion providers, outpatient facilities, physicians or specialty pharmacy.

If you don’t want to buy and bill a specialty pharmacy medication covered under the member’s medical benefit, you may order it through the following network specialty pharmacy:

Network Specialty Pharmacy

Phone Number

BriovaRx

855-427-4682

The following specialty pharmacies also provide certain types of specialty medications:

Network Specialty Pharmacy

Medication Category

Phone Number

Accredo (nursing services)

Enzyme Deficiency

Gaucher's Disease

Immune Globulin

Pulmonary Hypertension

800-803-2523

 

Option Care (nursing services)

Enzyme Deficiency

Gaucher's Disease

Hemophilia

Immune Globulin

Makena

866-827-8203

CVS Caremark Specialty Pharmacy

Pulmonary Hypertension

800-237-2767


Coverage of a requested medication depends on the member’s benefit, and availability of a specific drug from a network specialty pharmacy may vary.

Upon request, a specialty pharmacy can deliver the medication to your office or another site such as a member’s home.

Medications obtained through a specialty pharmacy will be directly billed to the patient’s health plan.

 

Pharmacy and Therapeutics Committee

If you are interested in speaking at a committee meeting, please refer to the following document Pharmacy and Therapeutics Committee Speaker Request Form (PDF 77.92 KB).

 

2018 Pharmacy & Therapeutics Committee Meetings

Thursday, April 5, 2018
5:00-6:30 p.m. Central Time