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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

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

 

Centennial Care - UnitedHealthcare Community Plan

Pharmacy Program

 

Preferred Drug List and Updates 

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by Centennial Care.

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

Preferred Drug List (PDL) Search  
Preferred Drug List  (PDF 1.21 MB)

4/1/2018 PDL Update (PDF 221.78 KB)
1/1/2018 PDL Update (PDF 62.98 KB)
10/1/2017 PDL Update (PDF 60.38 KB)
7/1/2017 PDL Update (PDF 122.49 KB)

 

Pharmacy Bulletins

New Mexico Synagis Form (PDF 102.29 KB)
Synagis Enrollment Form (PDF 225.02 KB)  
Synagis Program  (PDF 58.92 KB) 
Synagis Program 5 Doses (PDF 51.26 KB)

 

Quantity Limit Initiatives and Policy

Quantity Limit Policy (PDF 20.11 KB)

 

Step Therapy Information

Step Therapy Policy (PDF 21.02 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.

 

Medical Injectables

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.

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.


UnitedHealthcare Dual Complete® (HMO-POS SNP)
H5008-009


UnitedHealthcare Dual Complete® (PPO SNP)
H2228-042


UnitedHealthcare Dual Complete® (PPO SNP)
H2228-046