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UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) Lookup Tools
Find a Provider
2024 Provider/Pharmacy Directories
Prior Authorizations
Download the list of services that require prior authorizations.
Prior Authorization Process
Prior authorization is an okay for services that must be approved by UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan).
Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay on pages 19-22. Our UM team is available Monday through Friday, 8 a.m. to 5 p.m. On-call staff is available 24 hours a day, 7 days a week for emergency okays.
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) also reviews some of your services and care as they are happening. This is called concurrent review. Examples are when you are:
- A patient in the hospital
- Receiving home care by nurses
- Certain outpatient services such as speech therapy and physical therapy
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) reviews your progress with your doctor to be sure you still need those services or if other services would be better for you.
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) has policies and procedures to follow when the UM team makes decisions regarding medical services. The UM doctors and nurses make their decision based on your coverage and what you need for your medical condition. The goal is to make sure that services are medically necessary, that they are provided in an appropriate setting, and that quality care is provided.
We want to help you stay well. If you are sick we want you to get better.
- UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) does not pay employees extra for limiting your care.
- Our network doctors do not receive extra money or rewards if they limit your care.
If you have questions about UM decisions or processes, call Member Services at 1-877-542-9236 (TTY 711).
Appeal or Grievance
To file an Appeal or Grievance, please visit or FAQ section.
Find a Drug
2024 Formularies
Prior Authorizations
Pharmacy Prior Authorization Request to OptumRx
Prescription Drugs - Not Covered by Medicare Part D
While most of your prescription drugs will be covered by Medicare Part D, there are a few drugs that are not covered by Medicare Part D but are covered by UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan). You can view our plan’s List of Covered Drugs on our website at https://member.uhc.com/communityplan.
Drugs with an asterisk are not covered by Medicare Part D but are covered by UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan). You do not have any co-pays for non-Part D drugs covered by our plan.
Please note that our list of medications that require prior authorization can change so it is important for you and/or your provider to check this information when you need to fill/refill a medication.
Prescription Drug Transition Process
What to do if your current prescription drugs are not on the Drug List (formulary) or are restricted in some way
Drugs aren’t on list section
Sometimes, you may take a prescription drug that isn’t on your plan’s Drug List or it’s restricted in some way. Whether you’re a new member or a continuing member, there’s a way to get help.
Start by talking to your doctor. Your doctor can help decide if there’s another drug on the Drug List you can switch to. If there isn’t a good alternative drug, you, your representative or your doctor can ask for a formulary exception. If the exception is approved, you can keep getting your current drug for a certain period of time.
Review your Evidence of Coverage (EOC) to find out exactly what your plan covers. If you’re a continuing member, you’ll get an Annual Notice of Changes (ANOC). Review the ANOC carefully to find out if your current drugs will be covered the same way in the upcoming year.
Whether you’re switching drugs or waiting for an exception approval, you may be eligible for a transition supply of your current drug.
- You must get your 1-month supply, as described in EOC, during the first 90 days of membership with the plan as a new member OR within the first 90 days of the calendar year if you are a continuing member and your drug has encountered a negative formulary change.
- You may also be eligible for a one-time, temporary 1-month supply if you qualify for an emergency fill while residing in a long-term care (LTC) facility after the first 90 days as a new member or you have encountered a level of care change.
- If your doctor writes your prescription for fewer days and the prescription has refills, you may refill the drug until you’ve received at least a 1-month supply, as described in your EOC.
New members
As a new plan member, you may currently be taking drugs that are not on the plan’s formulary (drug list), or they are on the formulary but are restricted in some way.
In instances like these, start by talking with your doctor about appropriate alternative medications available on the formulary. If no appropriate alternatives can be found, you or your doctor can request a formulary exception. If the exception is approved, you may be able to obtain the drug for a specified period of time.
During the first 90 days of your membership in the plan if you are a new member, you can request at least a 1-month supply, as described in your plan’s Evidence of Coverage.
During the first 90 days of the calendar year if you were in the plan last year and your drug encountered a negative formulary change, you can request at least a 1-month supply, as described in your plan’s Evidence of Coverage.
Members who have unplanned transitions such as hospital discharges (including psychiatric hospitals) or level of care changes (i.e., changing long-term care facilities, exiting and entering a long-term care facility, ending Part A coverage within a skilled nursing facility, or ending hospice coverage and reverting to Medicare coverage) at any time during the plan year. You can request at least a 1-month supply, as described in your plan’s Evidence of Coverage.
Continuing members
As a continuing member in the plan, you receive an Annual Notice of Changes (ANOC). You may notice that a drug you are currently taking is either not on the upcoming year’s formulary or is on the formulary but restricted in some way in the upcoming year.
Starting October 15, 2023, you may request a 2024 coverage review. If your request is approved, the plan will cover the drug as of January 1, 2024.
If your drug is subject to new formulary restrictions on January 1, 2024 and you have not discussed switching to an alternative formulary medication or pursued a formulary exception with your doctor, you may receive a temporary supply within the first 90 days of the new calendar year when you go to a network pharmacy. This would be at least a 1-month supply, as described in your plan’s Evidence of Coverage, to allow you time to discuss alternative treatment with your doctor or to pursue a formulary exception.
If you live in a long-term care facility, you can obtain multiple refills until you’ve reached at least a 31-day supply, including when prescriptions are dispensed for less than the written amount due to drug utilization edits that are based on approved product labeling.
There may be unplanned transitions such as hospital discharges or level of care changes (i.e., changing long-term care facility or in the week before or after a long-term care discharge, end of skilled nursing facility stay and reverting to Part D coverage or when taken off hospice care) that can occur anytime. If you are prescribed a drug that is not on our formulary or your ability to get your drugs is restricted in some way, you are required to use the plan's exception process. For most drugs, you may request a one-time temporary supply of at least one month, as described in your plan’s Evidence of Coverage, to allow you time to discuss alternative treatment with your doctor or to pursue a formulary exception.
For members who have been in the plan for more than 90 days and reside in a long-term care (LTC) facility and need a supply right away, we will cover at least a 31-day temporary supply, as described in your plan’s Evidence of Coverage.
If you have any questions about this transition policy or need help asking for a formulary exception, contact a member services representative.
For prescription drug transition process information in Spanish, go to Forms and Resources and view section 5.2 of your Evidence of Coverage (Spanish) for more information.
If you’re out of medication after receiving a temporary transition supply and you’re working with your prescriber to switch to an alternative drug or request an exception, call the number on your member ID card or contact UnitedHealthcare Customer Service.
Related Information
The Coverage Determination Request Form may be found under Appeal a Coverage Decision section on this page.
Medication Therapy Management Program
UnitedHealthcare’s Medication Therapy Management (MTM) program was developed by a team of pharmacists and doctors. The MTM program provides members with a comprehensive medication review (CMR) with a pharmacist or other qualified health care provider. The program helps members understand their drug coverage and how to use their medications, and also educates members of potentially harmful drug interactions and/or risks of side effects.
How to Qualify
What You Need to Do
What's Next
How to Qualify
This program is available at no additional cost. You’ll be automatically enrolled in the Medication Therapy Management program if you:
- take eight (8) or more chronic Part D medications, and
- have three (3) or more long-term health conditions from the following list:
- Chronic obstructive pulmonary disease (COPD)
- Diabetes
- Heart Failure
- High Cholesterol
- Osteoporosis
- and are likely to spend more than $5,330 a year on covered Part D medications
OR
- are in a Drug Management Program to help better manage and safely use medications such as those for pain.
What You Need to Do
Within 60 days of becoming eligible for the MTM program, you’ll receive an offer by mail to complete a Comprehensive Medication Review (CMR). You may also receive this offer by phone.
You can complete the CMR by phone or in person with a qualified health care provider. It takes about 30 minutes. A pharmacist, or qualified CMR provider, will review your medication history, including prescription and over-the-counter medications, and look for any issues.
What's Next
Within 14 days of the CMR, you’ll receive a packet containing a summary of the review including action items discussed and a list of the medications you are taking and why you take them. This can be helpful when meeting with your doctor or pharmacist. The results may be sent to your doctor. In addition, members in the MTM program will receive information on the safe disposal of prescription medications including controlled substances.
You can also download a blank Medication List (PDF) for your own personal use.
In addition to the CMR, Targeted Medication Reviews are done at least quarterly. This is done to find any drug-drug interactions or other medication concerns. Those reviews will be sent to your doctor.
The Medication Therapy Management program isn’t a plan benefit. For more information on UnitedHealthcare’s Medication Therapy Management program, please call the number on the back of your plan member ID card or you may call the OptumRx MTM clinical call center team at 1-866-216-0198, TTY 711, Monday – Friday 9AM – 9PM EST.
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Dental Provider Search
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Prior Authorization Request
Prior Authorization Process
Prior authorization is an okay for services that must be approved by UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan).
Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay. Our UM team is available Monday through Friday, 8 a.m. to 5 p.m. On-call staff is available 24 hours a day, 7 days a week for emergency okays.
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) also reviews some of your services and care as they are happening. This is called concurrent review. Examples are when you are:
- A patient in the hospital
- Receiving home care by nurses
- Certain outpatient services such as speech therapy and physical therapy
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) reviews your progress with your doctor to be sure you still need those services or if other services would be better for you.
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) has policies and procedures to follow when the UM team makes decisions regarding medical services. The UM doctors and nurses make their decision based on your coverage and what you need for your medical condition. The goal is to make sure that services are medically necessary, that they are provided in an appropriate setting, and that quality care is provided.
We want to help you stay well. If you are sick we want you to get better.
- UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) does not pay employees extra for limiting your care.
- Our network doctors do not receive extra money or rewards if they limit your care.
If you have questions about UM decisions or processes, call Member Services at 1-877-542-9236 (TTY 711).
Appeal or Grievance
To file an Appeal or Grievance, please visit or FAQ section.
Find a Pharmacy
Find A Pharmacy
Search for a UnitedHealthcare network pharmacy below.
2024 Provider/Pharmacy Directories
Pharmacies
This part of the directory provides a list of pharmacies in UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) network. These network pharmacies are pharmacies that have agreed to provide prescription drugs to you as a member of the plan.
- UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) Members must use network pharmacies to get prescription drugs.
- You must use network pharmacies except in emergency or urgent care situations. If you go to an out-of-network pharmacy for prescriptions when it is not an emergency or urgent care situation, including when you are out of the service area, call UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) toll-free Member Services or 24-hour nurse advice line for assistance in getting your prescription filled.
- If you go to an out-of-network pharmacy for prescriptions when it is not an emergency, you will have to pay out of pocket for the service. Read the UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) Member Handbook for more information.
- Some network pharmacies may not be listed in this Directory.
- Some network pharmacies may have been added or removed from our plan after this Directory was published.
For up to date information about UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) network pharmacies in your area, please visit our web site at www.UHCCommunityPlan.com or call Member Services at 1-877-542-9236, TTY users should call 711, 8 a.m. - 8 p.m., local time, Monday - Friday. The call is free.
To get a complete description of your prescription coverage, including how to fill your prescriptions, please read the Member Handbook and UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) List of Covered Drugs. You received the List of Covered Drugs in the mail when you became a member of this plan. You may also visit our web site at www.UHCCommunityPlan.com for the drug list.
Identifying Pharmacies in Our Network
Along with retail pharmacies, your plan’s network of pharmacies includes:
- Mail-Order Pharmacies
- Home infusion pharmacies
- Long-term care (LTC) pharmacies
You are not required to continue going to the same pharmacy to fill your prescriptions. You can go to any of the pharmacies in our network.
Mail Order Pharmacy(ies)
You can get prescription drugs shipped to your home through our network mail order delivery program which is called OptumRx® home delivery pharmacy. Prescription orders sent directly from your doctor must have your approval before we can send your medications. This includes new prescriptions and prescriptions refills. We will contact you, by phone, to get your approval. If we are unable to reach you for approval, your prescription will not be sent to you.
You also have the choice to sign up for automated mail order delivery through our OptumRx® home delivery pharmacy. Typically, you should expect to get your prescription drugs from 4 to 6 days from the time that the mail order pharmacy gets the order.
If you do not get your prescription drug(s) within this time, if you would like to cancel an automatic order, or if you need to ask for a refund for prescriptions you got that you did not want or need, please contact us at 1-877-542-9236, TTY 711, 8 a.m. - 8 p.m., local time, Monday - Friday.
Home Infusion Pharmacies
You can get home infusion therapy if UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) has approved your prescription for home infusion therapy and if you get your prescription from an authorized prescriber.
For more information, please see your Member Handbook, or call Member Services at 1-877-542-9236, TTY 711, 8 a.m. - 8 p.m., local time, Monday - Friday.
Long-Term Care Pharmacies
Residents of a long-term care facility, such as a nursing home, may access their prescription drugs covered under UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) through the facility’s pharmacy or another network pharmacy.
For more information, you can call Member Services at 1-877-542-9236, TTY 711, 8 a.m. - 8 p.m., local time, Monday - Friday.
Prior Authorizations
Prior authorization is an okay for services that must be approved by UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan). Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay. Our UM team is available Monday through Friday, 8 a.m. to 5 p.m. On-call staff is available 24 hours a day, 7 days a week for emergency okays.
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) also reviews some of your services and care as they are happening. This is called concurrent review. Examples are when you are:
- A patient in the hospital
- Receiving home care by nurses
- Certain outpatient services such as speech therapy and physical therapy
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) reviews your progress with your doctor to be sure you still need those services or if other services would be better for you.
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) has policies and procedures to follow when the UM team makes decisions regarding medical services. The UM doctors and nurses make their decision based on your coverage and what you need for your medical condition. The goal is to make sure that services are medically necessary, that they are provided in an appropriate setting, and that quality care is provided.
We want to help you stay well. If you are sick we want you to get better.
- UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) does not pay employees extra for limiting your care.
- Our network doctors do not receive extra money or rewards if they limit your care.
If you have questions about UM decisions or processes, call Member Services at 1-877-542-9236 (TTY 711).
Prior Authorization Request
Prescription Drug Transition Process
What to do if your current prescription drugs are not on the formulary or are limited on the formulary.
New Members
As a new member of UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan), insured through UnitedHealthcare, you may currently be taking drugs that are not on the UnitedHealthcare® formulary (drug list), or they are on the formulary but your ability to get them is limited.
In instances like these, start by talking with your doctor about appropriate alternative medications available on the formulary. If no appropriate alternatives can be found, you or your doctor can request a formulary exception. If the exception is approved, you will be able to obtain the drug for a specified period of time. While you and your doctor are determining your course of action, you may be eligible to receive an initial 31-day transition supply (unless your prescription is written for fewer days) of the drug anytime during the first 90 days you are a plan member.
For each of your drugs that is not on the formulary or if your ability to get your drugs is limited, UnitedHealthcare will cover a 31-day supply (unless your prescription is for fewer days) when you go to a network pharmacy. If the prescription is written for less than 31 days, multiple fills are allowed to provide up to a total of 31 days of drugs. After your first 31-day transition supply, these drugs may not continue to be covered. Talk with your doctor about appropriate alternative medications. If there are none on the formulary, you or your doctor can request a formulary exception.
If you live in a long-term care facility, UnitedHealthcare will cover a temporary 31-day transition supply (unless your prescription is for fewer days). UnitedHealthcare will cover more than one refill of these drugs for the first 90 days for plan members, up to a 93-day supply. If you need a drug that is not on the formulary or your ability to get your drugs is limited, but you are past the first 90 days of plan membership, the transition program will cover a 31-day emergency supply of that drug (unless your prescription is for fewer days) while you pursue a formulary exception.
You may face unplanned transitions after the first 90 days of plan enrollment, such as hospital discharges or level of care changes (i.e., in the week before a long-term care discharge), If you are prescribed a drug that is not on the formulary or your ability to get your drugs is limited, you are required to use the plan's exception process. You can request a one-time emergency supply of up to 31 days to allow you time to discuss alternative treatment with your doctor or to pursue a formulary exception.
Continuing Members
As a continuing member in the plan, you receive an Annual Notice of Changes (ANOC). You may notice that a formulary medication you are currently taking is either not on the upcoming year's formulary or its cost sharing or coverage is limited in the upcoming year.
For coverage requests received each year by December 15, and approved, the plan will cover the drug as of January 1. For coverage requests initiated on or after December 16, normal time frames for resolution apply: you will receive an answer within 24 hours for urgent requests and within 72 hours for all other requests. If your request is still in process on January 1, you may receive a temporary supply of the drug for your current plan cost-sharing until your request is answered.
If you have any questions about this transition policy or need help asking for a formulary exception, a UnitedHealthcare representative can help.
Related Information
The Coverage Determination Request Form may be found under Appeal a Coverage Decision section on this page.
Learn More
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) H2531-001-000