Pharmacy Resources and Physician Administered Drugs

Find pharmacy information related to prescription drugs including prescription drug lists, step therapy, quantity limits and prior authorization requirements for Community Plan care providers.  

Prior Authorization Information for Your Patient’s Medicaid Pharmacy Benefit

Effective July 1, 2021, the North Carolina Department for Medicaid Services requires UnitedHealthcare Community Plan to follow the North Carolina Fee-For-Service PDL and Clinical Criteria. Additional pharmacy benefit and medication information can be found below in this section to assist our providers.

North Carolina Pharmacy Services Clinical Coverage Policies can be found in the Clinical Pharmacy Guidelines

For submission of a prior authorization for a UnitedHealthcare Community Plan of North Carolina Member:

Prior Authorization Requests - Prescribers may submit prior authorizations for Community Plan Members:

  • By calling 855-258-1593 or by fax at 866-940-7328
  • Online at uhcprovider.com> Link Sign In (top right) > sign in with your One Healthcare ID > Prior Authorization & Notification application

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

Other Resources

All pharmacy providers shown are contracted for both Medicaid and Health Choices.

Pharmacy Paper Prior Authorization Forms

For submission of a prior authorization for a UnitedHealthcare Community Plan of North Carolina:

Prior Authorization Requests - Prescribers may submit prior authorizations for Community Plan Members: 

  • By calling 855-258-1593 or by fax at 866-940-7328
  • Online at uhcprovider.com > Sign In (top right) > sign in with your One Healthcare ID > Prior Authorization & Notification application

Streamline Your Prior Authorization Process with CoverMyMeds

CoverMyMeds streamlines the medication prior authorization process, electronically connecting providers, pharmacists and plan/PBMs to improve time to therapy and decrease prescription abandonment with electronic prior authorization.

Get Real-Time Prescription Costs and Coverage Detail

The PreCheck MyScript Solution on Link helps make it easy to run a pharmacy trial claim and get real-time prescription coverage detail for your patients who are UnitedHealthcare benefit plan members.

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.

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. 

Additional Pharmacy Resources