Please select the state where you practice.

Pharmacy Program 

 

icon-checklist-grey

Looking for Paper Pharmacy Prior Authorization Fax Forms? They are now available at UHCprovider.com 

 

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)


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

 

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:

Nebraska Preferred Drug List

UnitedHealthcare Community Plan of Nebraska Preferred Drug List (PDF 1.39 MB)

Pharmacy Preferred Drug List (PDL) Lookup Tool

 

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
Phone: 952-406-4955
Toll Free:  800-284-0626
Fax:  888-868-5011

 


UnitedHealthcare Community Plan - Heritage Health

Pharmacy Program 


Pharmacy Bulletins

Synagis Enrollment Form (PDF 225.02 KB)  
Synagis Program (PDF 58.92 KB) 
Synagis Program 5 Doses (PDF 51.26 KB)

 

 

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.

Specialty Pharmacy Medications
Specialty Pharmacy Medications
Specialty Pharmacy Medications

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 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.

Nebraska MAC Price Lookup

MAC Appeal Submission Guide

 

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


UnitedHealthcare Dual Complete® (HMO SNP)
H0169-003