Find pharmacy information related to prescription drugs including prescription drug lists, step therapy, quantity limits and prior authorization requirements for Community Plan care providers.
On July 1, 2021, we will work with a new Pharmacy Benefits Manager, MedImpact.
All prior authorizations will be managed by MedImpact.
Pharmacy Prior Authorization:
Prescribers can submit requests:
• Online: Care providers can submit prior authorization requests online through Cover My Meds, Surescripts, or CenterX ePA portals.
• Fax: They can fax completed prior authorization forms to 858-357-2612 beginning July 1, 2021.
• Phone: Call 844-336-2676 from 8 a.m. to 7 p.m., Monday through Friday, Eastern Time.
For all medically billed drug (Jcode) PA requests, please continue to send those directly to the United Healthcare for review.
Effective January 1, 2021, the Kentucky Department for Medicaid Services (DMS) requires UnitedHealthcare Community Plan to follow the Kentucky Fee-For-Service PDL and Clinical Criteria. Additional pharmacy benefit and medication information can be found below in this section to assist our providers.
Kentucky PDL information can be found in the Preferred Drug Guide.
For submission of a prior authorization for a UnitedHealthcare Community Plan of Kentucky Member:
Prior Authorization Requests - Prescribers may submit prior authorizations for Community Plan Members:
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.
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.
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:
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.