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Pharmacy Program

 

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

 

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

Pharmacy Program

 

Preferred Drug List and Updates

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

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

Preferred Drug List (PDL) Search
Preferred Drug List (PDL)
(PDF 2.09 MB)

7/1/2018 PDL Update (PDF 77.12 KB) 
4/1/2018 PDL Update (PDF 215.66 KB)
1/1/2018 PDL Update
(PDF 63.37 KB)
10/1/2017 PDL Update (PDF 59.58 KB)


Step Therapy Program 

Step Therapy Policy (PDF 16.75 KB)


Drug Quantity Limits 

Quantity Limit Policy (PDF 24.38 KB)

 

Pharmacy Bulletins


Synagis Enrollment Form (PDF 112.99 KB)  
Synagis Program (PDF 58.92 KB) 
Synagis Program 5 Doses (PDF 51.26 KB)

Pharmacy Bulletins


Synagis Enrollment Form (PDF 112.99 KB)  
Synagis Program (PDF 58.92 KB) 
Synagis Program 5 Doses (PDF 51.26 KB)

Pharmacy Bulletins

Synagis Enrollment Form (PDF 112.99 KB)  
Synagis Program (PDF 58.92 KB) 
Synagis Program 5 Doses (PDF 51.26 KB)

Makena Frequently Asked Questions  (PDF 57.78 KB)


Prior Authorization List (PDF 342.35 KB)

 

Clinical Guidelines

Our Clinical Pharmacy Program Guidelines are updated on an ongoing basis by our Pharmacy and Therapeutics Committee. Our changes reflect recent developments in pharmaceutical health care so we’re aligned with national treatment standards.

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.

MAC lists are reviewed twice weekly with additional updates implemented on an as-needed basis based on market forces and other additional information.

For Ohio Medicaid MAC inquiries, please contact OptumRx through email at medicaid_macappeal@optum.com.

If you believe a specific claim was paid incorrectly, please download this appeals form, and review the MAC appeals submissions guide for instructions.

If you have questions related to your contract with us or other issues related to the UnitedHealthcare Community Plan of Ohio Pharmacy Network, please feel free to contact our network relations line at 1-800-613-3591.

Email: pharmacycontracts@optum.com
For contracting Issues: 1-800-613-3591
Claims processing issues: 1-877-231-0131
Fax: 1-866-811-4224


UnitedHealthcare Connected® for MyCare Ohio
H2531-001

Pharmacy Program 

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by UnitedHealthcare Connected for MyCare Ohio
H2531-001.

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

Preferred Drug List (PDL) Search

Download (PDF 968.84 KB) the Acrobat version of the Preferred Drug List (PDL)


UnitedHealthcare Dual Complete® (HMO SNP)
H5253-059


UnitedHealthcare Dual Complete® (HMO-POS SNP)
H5322-028