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On Jan. 1, 2017, UnitedHealthcare Community Plan of Nebraska began serving Heritage Health members. To avoid disruption of care, we honored previously approved prescription medication authorizations for the first 90 days. The 90-day transition of care period for pharmaceuticals ended on April 1, 2017. Care providers may need to submit prior authorization requests and renewals.
To learn more about pharmacy benefit coverage:
Member Pharmacy Benefit Coverage – Effective Jan. 1, 2017 (PDF 134.66 KB)
Pharmacy Benefit Resources
Medicaid Pharmacy Benefit Frequently Asked Questions (PDF 246.66 KB)
Pharmacy Program Overview (PDF 745.74 KB)
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)
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
State of Nebraska Preferred Drug List
The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by the Nebraska Department of Medicaid. View the PDL as produced by the state of Nebraska:
Pharmacy Providers Dispensing Durable Medical Equipment (DME)
If you would like to be contracted for DME services offered to UnitedHealthcare Community Plan - Heritage Health members, contact Sr. Network Account Manager Angela Hogan at:
Email : Angela_hogan@uhc.com
Toll Free: 800-284-0626
UnitedHealthcare Community Plan - Heritage Health
Specialty Pharmacy Medications
Prior authorization is required for some services and medications.
Click the arrow below to view a current list of services and information on how to request an authorization.
Click on the arrow above to view medical injectable information.
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
The following specialty pharmacies also provide certain types of specialty medications:
Network Specialty Pharmacy
Accredo (nursing services)
Option Care (nursing services)
CVS Caremark Specialty Pharmacy
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 Contact Information
Rx Claims Processing Technical Assistance: Contact the OptumRx Help Desk at
877-231-0131, 24 hours a day, 7 days a week.
Pharmacy Prior Authorization Assistance: Contact our Pharmacy Prior Authorization line at 800-310-6826.
Medical DME Questions: Contact our Provider Service Center at 866-331-2243.
MAC Price Lookup and Appeals
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.
Pharmacies with specific claim related questions should contact OptumRx at 1-877-305-8952, Available 24 hours daily, 7 days a week.