unitedhealthcare community plan pharmacy list

October 12th, 2020 by

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startxref 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.

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Information related to pharmacy coverage decisions based on an understanding of how health plan coverage affects total member health care including drug lists, supply limits and step therapy. State Required Promotion of COVID-19 Testing, Community Plan Reimbursement Policies of Maryland, Massachusetts AARP® Medicare Advantage Plans, Massachusetts Erickson Advantage® Freedom/Signature Plans, Massachusetts Erickson Advantage® SNP Plans, Massachusetts Group Medicare Advantage Plans, Massachusetts UnitedHealthcare Senior Care Options Plan, Community Plan Reimbursement Policies of Massachusetts, Michigan Erickson Advantage® Freedom/Signature Plans, Advancing Health Equity Multi-Credit Education, Community Plan Reimbursement Policies of Michigan, Minnesota UnitedHealthcare Medicare Advantage Plans, A Team Approach to Managing Members with Diabetes, UnitedHealthcare Dual Complete: Mississippi Members Matched with a Navigator, Community Plan Reimbursement Policies of Mississippi, Missouri UnitedHealthcare Medicare Advantage Plans, Missouri UnitedHealthcare® MedicareDirect (PFFS), Community Plan Reimbursement Policies of Missouri, Montana UnitedHealthcare® MedicareDirect (PFFS), Nebraska UnitedHealthcare® MedicareDirect (PFFS), Community Plan Reimbursement Policies of Nebraska, Nevada UnitedHealthcare Medicare Advantage Assist, New Hampshire AARP® Medicare Advantage Plans, New Hampshire Group Medicare Advantage Plans, New Hampshire UnitedHealthcare Medicare Advantage Plans, New Jersey AARP® Medicare Advantage Plans, New Jersey Erickson Advantage® Freedom/Signature Plans, New Jersey Group Medicare Advantage Plans, Managed Long-Term Care Services and Supports (MLTSS), Community Plan Reimbursement Policies of New Jersey, New Mexico AARP® Medicare Advantage Plans, New Mexico Group Medicare Advantage Plans, New Mexico UnitedHealthcare Medicare Advantage Plans, New York UnitedHealthcare Medicare Advantage Plans, New York UnitedHealthcare Dual Complete® Special Needs Plans, Community Plan Reimbursement Policies of New York, North Carolina AARP® Medicare Advantage Plans, North Carolina Erickson Advantage® Freedom/Signature Plans, North Carolina Erickson Advantage® SNP Plans, North Carolina Group Medicare Advantage Plans, Community Plan Medical & Drug Policies for North Carolina, North Dakota Group Medicare Advantage Plans, North Dakota AARP® Medicare Advantage Plans, North Dakota UnitedHealthcare Medicare Advantage Plans, ODM is Requiring Providers to Register NPIs for Payments, UnitedHealthcare Dual Complete: Ohio Members Matched with a Navigator, Community Plan Reimbursement Policies of Ohio, Oklahoma UnitedHealthcare® MedicareDirect (PFFS), Pennsylvania AARP® Medicare Advantage Plans, Pennsylvania Erickson Advantage® SNP Plans, Pennsylvania Erickson Advantage® Freedom/Signature Plans, Pennsylvania Group Medicare Advantage Plans, Community Plan Reimbursement Policies of Pennsylvania, Rhode Island AARP® Medicare Advantage Plans, Rhode Island Group Medicare Advantage Plans, Community Plan Reimbursement Policies of Rhode Island, South Carolina UnitedHealthcare Medicare Advantage Plans, South Dakota Group Medicare Advantage Plans, South Dakota AARP® Medicare Advantage Plans, Fraud, Waste, and Abuse Update – Foot Baths and Prescription Anti-Infective Agents, Healthcare Professional Community Engagement Partnership, UnitedHealthcare Dual Complete – Medicare Advantage Special Needs Plan (DSNP) and UnitedHealthcare Community Plan – TennCare, Community Plan Reimbursement Policies of Tennessee, Tennessee Episodes of Care / Patient Centered Medical Home / TN Health Link / Medication Therapy Management, TX UnitedHealthcare® Chronic Complete Special Needs Plan, TX Erickson Advantage® Freedom/Signature Plans, Texas UnitedHealthcare Medicare Advantage Plans, TX UnitedHealthcare® MedicareDirect (PFFS), Messages from the Texas Credentialing Alliance, Messages from the Texas Health and Human Services Commission, Community Plan Reimbursement Policies of Texas, Reference Guides and Value-Added Services, Utah UnitedHealthcare Medicare Advantage Plans, Utah UnitedHealthcare Medicare Advantage Assist plans, VT UnitedHealthcare® MedicareDirect (PFFS), Vermont UnitedHealthcare Medicare Advantage Plans, Virginia Erickson Advantage® Freedom/Signature Plans, Virginia UnitedHealthcare® MedicareDirect (PFFS), Resources to Help You Prepare for a Challenging Influenza Season, Community & State Plan: 2020 Transportation Benefit Information, Initiation and Engagement of Alcohol and Other Drug Dependence Treatment, Medication Reconciliation Post-Discharge (MRP), UnitedHealthcare Dual Complete: Virginia Members Matched with a Navigator, Community Plan Reimbursement Policies of Virginia, Washington AARP® Medicare Advantage Plans, Washington Group Medicare Advantage Plans, Community Plan Reimbursement Policies of Washington, West Virginia AARP® Medicare Advantage Plans, West Virginia Group Medicare Advantage Plans, Wisconsin UnitedHealthcare Medicare Advantage Plans, Wisconsin UnitedHealthcare Medicare Advantage Assist plans, Community Plan Reimbursement Policies of Wisconsin, Wyoming UnitedHealthcare® MedicareDirect (PFFS), U.S. Virgin Islands Commercial Health Plans, UnitedHealthcare Commercial Medical & Drug Policies and Coverage Determination Guidelines, Physical Medicine & Rehabilitation: Speech Therapy Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Procedure to Modifier Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Outpatient Hospital CCI Editing Policy, Facility - Reimbursement Policy - UnitedHealthcare Commercial Plans, Physical Medicine & Rehabilitation: PT, OT and Evaluation and Management Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Preventive Medicine and Screening Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Observation and Discharge Policy, Professional - UnitedHealthcare Commercial Plans, Outpatient Hospital Maximum Frequency Per Day Policy, Facility - Reimbursement Policy - UnitedHealthcare Commercial Plans, Durable Medical Equipment, Orthotics and Prosthetics Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Split Surgical Package Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Professional/Technical Component Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, After Hours and Weekend Care Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Prolonged Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Procedure and Place of Service Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Time Span Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Inappropriate Primary Diagnosis Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Obstetrical Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Global Days Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Microsurgery Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Drug Testing Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Emergency Department (ED) Facility Evaluation and Management (E&M) Coding Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Multiple Procedure Payment Reduction (MPPR) for Medical and Surgical Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Wrong Surgical or Other Invasive Procedures Policy, Professional and Facility - Reimbursement Policy - UnitedHealthcare Commercial Plans, Once in a Lifetime Procedures Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Replacement Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Services and Modifiers Not Reimbursable to Healthcare Professionals Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Same Day / Same Service Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Maximum Frequency Per Day Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Increased Procedural Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Mohs Micrographic Surgery Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Nonphysician Health Care Professionals Billing Evaluation and Management Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, One or More Sessions Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, New Patient Visit Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Co-Surgeon / Team Surgeon Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Non-Patient Facility Laboratory Services Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Advanced Practice Health Care Provider Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Pediatric and Neonatal Critical and Intensive Care Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Contrast and Radiopharmaceutical Materials Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Care Plan Oversight Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Assistant-at-Surgery Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Add-On Codes Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Intraoperative Neuromonitoring Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Modifier SU Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Urgent Care Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Reduced Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Ambulance Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Non-Physician Health Care Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Intensity Modulated Radiation Therapy Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Anesthesia Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Supply Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Multiple Procedure Payment Reduction (MPPR) for Diagnostic Cardiovascular and Ophthalmology Procedures Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Rebundling Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Modifier Reference Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Outpatient Hospital Add-On Codes Policy, Facility - Reimbursement Policy - UnitedHealthcare Commercial Plans, Standby Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Discontinued Procedure - Reimbursement Policy - UnitedHealthcare Commercial Plans, National Drug Code (NDC) Requirement Professional & Facility Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, From – To Date Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plan, T Status Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Acupuncture Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Robotic Assisted Surgery Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Evaluation and Management (E/M) Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Molecular Pathology Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Bilateral Procedures Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Discarded Drugs and Biologicals Policy, Professional and Facility Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, CCI Editing Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Physical Medicine & Rehabilitation: Multiple Therapy Procedure Reduction Policy, Professional, Molecular Pathology Policy, Frequently Asked Questions - Reimbursement Policy - UnitedHealthcare Commercial Plans, Injection and Infusion Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Telehealth and Telemedicine Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Laboratory Services Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, B Bundle Codes Policy Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Physical Medicine & Rehabilitation: Maximum Combined Frequency Per Day Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, Multiple Procedure Payment Reduction (MPPR) for Diagnostic Imaging Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans, Clinical Laboratory Improvement Amendments (CLIA) ID Requirement Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans, UnitedHealthcare West Benefit Interpretation Policies, UnitedHealthcare West Medical Management Guidelines, UnitedHealthcare Value & Balance Exchange Medical & Drug Policies and Coverage Determination Guidelines, Medicare Advantage Reimbursement Policies, Community Plan Drug Lists for Limited Supplier Protocol, Community Plan Care Provider Manuals for Medicaid Plans By State, Welcome to UnitedHealthcare 2020 UnitedHealthcare Administrative Guide, Manuals and Benefit Plans Referenced in the Guide, Verifying Eligibility, Benefits and Your Network Participation, Network Participating Care Provider Responsibilities, Cooperation with Quality Improvement and Patient Safety Activities, Notification of Practice or Demographic Changes (Applies to Commercial Benefit Plans in California), Administrative Terminations for Inactivity, Coverage Summaries and Policy Guidelines for MA Members, Dual Special Needs Plans Managed by Optum, Free Medicare Education for Your Staff and Patients, Non-Participating Care Provider Referrals (All Commercial Plans), Medicare Advantage Referral Required Plans, Benefit Plans Not Subject to this Protocol, Advance Notification/Prior Authorization Requirements, Advance Notification/Prior Authorization List, Facilities: Standard Notification Requirements, How to Submit Advance or Admission Notifications/ Prior Authorizations, Updating Advance Notification or Prior Authorization Requests, Coverage and Utilization Management Decisions, Clinical Trials, Experimental or Investigational Services, Medical Management Denials/Adverse Determinations, Outpatient Cardiology Notification/Prior Authorization Protocol, Outpatient Radiology Notification/Prior Authorization Protocol, Specialty Pharmacy Requirements for Certain Specialty Medications (Commercial Plans - Not Applicable to UnitedHealthcare West) - Chapter 7, 2020 UnitedHealthcare Administrative Guide, Non-Emergent Ambulance Ground Transportation, Medicare Advantage Claim Processing Requirements, Pass-through Billing/CLIA Requirements/Reimbursement Policy, Special Reporting Requirements for Certain Claim Types, Claim Reconsideration, Appeals Process and Resolving Disputes, Medical Records Standards and Requirements, Commercial Health Services, Wellness and Behavioral Health Programs, Commercial and Medicare Advantage Behavioral Health Information, UnitedHealth Premium Designation Program (Commercial Plans), Star Ratings for MA and Prescription Drug Plans, Credentialing/Profile Reporting Requirements, Care Provider Rights Related to the Credentialing Process, Credentialing Committee Decision Making Process (Non-Delegated), Medicare Compliance Expectations and Training, Examples of Potentially Fraudulent, Wasteful, or Abusive Billing (not an inclusive list), Reporting Potential Fraud, Waste or Abuse to UnitedHealthcare, How to Contact All Savers, All Savers Supplement, How to Contact Us, Capitation and/or Delegation, Verifying Eligibility and Effective Dates, Capitation and/or Delegation, Commercial Eligibility, Enrollment, Transfers and Disenrollment, Capitation and/or Delegation, Medicare Advantage (MA) Enrollment, Eligibility and Transfers, and Disenrollment, Capitation and/or Delegation, Authorization Guarantee, Capitation and/or Delegation, Care Provider Responsibilities, Capitation and/or Delegation, Delegated Credentialing Program, Capitation and/or Delegation, Medical Management, Capitation and/or Delegation, Pharmacy, Capitation and/or Delegation Supplement, Facilities, Capitation and/or Delegation Supplement, Claims Processes, Capitation and/or Delegation Supplement, Claims Disputes and Appeals, Capitation and/or Delegation Supplement, Capitation Reports and Payments, Capitation and/or Delegation Supplement, Contractual and Financial Responsibilities, Capitation and/or Delegation Supplement, CMS Premiums and Adjustments, Capitation and/or Delegation Supplement, Delegate Performance Management Program, Capitation and/or Delegation Supplement, Appeals and Grievances, Capitation and/or Delegation Supplement, Confidentiality of Protected Health Information (PHI), Member Rights and Responsibilities, Medica, Documentation and Confidentiality of Medical Records, Provider Reporting Responsibilities, Medica, Discharge of a Member from Participating Provider's Care, Quality Management and Health Management Programs, Care Provider Responsibilities and Standards, Oxford, Using Non-Participating Health Care Providers or Facilities, Oxford, Radiology, Cardiology and Radiation Therapy Procedures, Claims Recovery, Appeals, Disputes and Grievances, Case Management and Disease Management Programs, Medical and Administrative Policy Updates, Oxford, Confidentiality of Protected Health Information (PHI), Preferred Care Partners, Prior Authorizations and Referrals, Preferred Care Partners, Clinical Coverage Review, Preferred Care Partners, Appeal & Reconsideration Processes, Preferred Care Partners, Documentation and Confidentiality of Medical Records, Preferred Care Partners, Case Management and Disease Management Program Information, Preferred Care Partners, Special Needs Plans, Preferred Care Partners, Care Provider Reporting Responsibilities, Preferred Care Partners, UnitedHealthcare West Information Regarding our Care Provider Website, How to Contact UnitedHealthcare West Resources, Care Provider Responsibilities, UnitedHealthcare West, Utilization and Medical Management, UnitedHealthcare West, Hospital Notifications, UnitedHealthcare West, Care Provider Claims Appeals and Disputes, UnitedHealthcare West, California Language Assistance Program (California Commercial Plans), UnitedHealthcare West, Member Complaints & Grievances, UnitedHealthcare West, California Quality Improvement Committee, UnitedHealthcare West, Member Complaints & Grievances, UnitedHealthOne, Home Health and SNF High-Performing Provider Initiative Lists, Quality-Based Physician Incentive Program (QPIP), UnitedHealthcare Capitation, Claim, Quality, Roster and Profile Reports, UnitedHealthcare West Capitation, Settlement, Shared Risk Claims, Eligibility, and Patient Management Reports, UnitedHealthcare Prescription Drug Lists (PDL) / Drug Formulary, Prescription Drug List - Commercial - Effective September 1, 2020, Prescription Drug List - Commercial - Effective May 1, 2020, Prescription Drug List - Commercial - Effective January 1, 2020, Prescription Drug List - Essential - Colorado Doctor’s Plan - Effective September 1, 2020, Prescription Drug List - Essential - Effective May 1, 2020, Prescription Drug List - Essential - Effective January 1, 2020, Prescription Drug List - Essential - Colorado Doctor’s Plan - Effective July 1, 2019, Prescription Drug List - Essential - Colorado Doctor’s Plan - Effective January 1, 2019, Medicare Advantage Drug Formulary - UHCMedicareSolutions.com (enter zipcode, select plan), Pharmacy Benefit Coverage Update - Effective September 1, 2020, Pharmacy Benefit Coverage Update - Effective May 1, 2020 & July 1, 2020, Pharmacy Benefit Coverage Update - Effective January 1, 2020, Enroll in Emailing Clinical Information for Pharmacy Appeal - Medicare, Prior Authorization, Notification and Medical Necessity - Commercial, Learn more about Commercial Prior Authorization and Medication Notification, View Commercial Clinical Pharmacy Requirements, Find Commercial Pharmacy Specific Step Therapy Programs, Supply Limits, Pharmacy Medical Benefit - Commercial, Quantity Duration (QD) Supply Limits per Duration Medication List, Quantity Level Limits (QLL) Supply Limits per Copay Medication List, Learn more about the Specialty Pharmacy Program, Opioid Programs and Resources - Commercial, Opioid Overutilization Cumulative Drug Utilization Review Criteria, Quick Reference Guide: Opioid Overutilization Prevention and Opioid Use Disorder Treatment Programs, Short-Acting Opioid Review Criteria for Opioid Naive Members, Medicated Assisted Treatment: Locate a Provider (Optum Behavioral Network), Non-Opioid Alternatives for Treating Pain, Member Brochure: Learn to Safely Use Opioid Medications, Opioid Supply Limits - Greater than 34 Day Supply for Opioids at Retail, Opioid Use Disorder - Quick Reference Guide for Clinicians, UnitedHealthcare Oral Health and Opioids Toolkit, Agency for Healthcare Research and Quality (AHRQ) Interagency Guideline on Prescribing Opioids for Pain, Centers for Disease Control (CDC) Guideline for Prescribing Opioids for Chronic Pain, Centers for Disease Control (CDC) Fact Sheet, Centers for Disease Control (CDC) Opioid Overdose Guideline Resources, Opioid Programs and Resources - Community Plan (Medicaid), Interagency Guideline on Prescribing Opioids for Pain, CDC Guideline for Prescribing Opioids for Chronic Pain, Opioid Programs and Resources - Medicare Advantage, 2020 Opioid Readiness: Medicare Advantage and Prescription Drug Plans Quick Reference Guide, Medicare Safe use of opioid pain medication, Opioid Provider Letter Issued by the Centers for Medicare & Medicaid Services (CMS), California Doctors Plan Prescription Drug Lists (PDLs), Prescription Drug List - Essential - California Doctors Plan, Prescription Drug List - Advantage - 3 Tier - California Doctors Plan, Prescription Drug List - Advantage - 4 Tier - California Doctors Plan, Empire Plan Advanced Flexible Formulary - January 2020, Empire Plan Flexible Formulary - January 2020, UnitedHealthcare Oxford Commercial Pharmacy Resources, Buprenorphine/Naloxone products: Bunavail and Suboxone – Oxford, Diabetes Medications, DPP4 Inhibitors – Oxford, Diabetes Medications, GLP-1 Receptor Agonists - Oxford, Diabetes Medications, SGLT2 Inhibitors – Oxford, 2020 SignatureValue Three-Tier Drug Formulary (Effective September 1, 2020), UnitedHealthcare Community Plan for Medicaid, UnitedHealthcare Neighborhood Health Partnership, River Valley Plans Prescription Drug Lists, Advantage Plan Drugs Requiring Preauthorization (pdf), Traditional Plan Drugs Requiring Preauthorization (pdf), River Valley Pharmacy program 90/100 day list (pdf), Patient Protection and Affordable Care Act $0 Cost-Share Preventive Medications Exemption Requests (Commercial Members), Pharmacy Update - Notice of Changes to Prior Authorization Requirements and Coverage Criteria for UnitedHealthcare Commercial & Oxford - October 1, 2020, Drugs with Clinical Programs / Pharmacy Benefit Programs Drug List - Commercial Plans, January 1, 2020 – Levemir Exclusion Delayed.

You can also view a general list of pharmacies using the OptumRx Pharmacy Network Search.

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