Pharmacy Resources and Physician Administered Drugs

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

• Opioid Prescriber Reference Guide
• Opioid Tapering Recommendations (Last Modified 01.08.2020)

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
• Centers for Disease Control and Prevention (CDC): CDC Opioid Overdose Guideline Resources

See below for current pharmacy clinical guidelines and updates.

Visit the Policies and Clinical Guidelines page for more information. 

• Pharmacy Prior Authorization Request Form

•  Preferred Diabetic Supply Products

Preferred Drug List

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

• UnitedHealthcare Community Plan of California Medi-Cal Preferred Drug List Search
• UnitedHealthcare Community Plan of California Medi-Cal Preferred Drug List
• Machine Readable PDL

Preferred Drug List Updates

• Preferred Drug List Update - January 1, 2021
• Preferred Drug List Update - October 1, 2020
• Preferred Drug List Update - July 1, 2020
• Preferred Drug List Update - April 1, 2020

Specialty pharmacy medications covered under the member’s medical benefit may be provided through various sources ‒ home infusion providers, outpatient facilities, physicians or specialty pharmacy.

Network Specialty Pharmacies 

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 pharmacies:

• Optum Specialty Pharmacy: 855-427-4682 
• Accredo: 800-803-2523
• Biologics: 800-850-4306
• Caremark Specialty Pharmacy: 800-237-2767
• Eversana: 800-305-7881
• Option Care Health: 866-827-8203
• Orsini Pharmaceutical Services: 800-410-8575
• PantheRx: 855-726-8479
• US Bioservices: 888-518-7246

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.