Nebraska Medicaid and Long-Term Care (MLTC) has expanded Medicaid coverage under the Heritage Health Adult (HHA) Expansion program. The HHA program expands Medicaid coverage to adults, ages 19–64, whose income is at or below 138% of the federal poverty level. Heritage Health Adult members are enrolled in managed care plans through the existing Heritage Health program and are eligible for the same benefit package. This includes comprehensive medical, behavioral health and prescription drug coverage as well as vision services, dental services and over-the-counter (OTC) medication benefits.
The Nebraska Department of Health and Human Services (DHHS) also has information on the Medicaid expansion available at dhhs.ne.gov.
UnitedHealthcare Community Plan works with OptumRx to manage the Pharmacy network. Multiple sources are used by OptumRx in order to assure the Maximum Allowable Cost (MAC) list accurately reflects market pricing and availability of generic drugs.
Sources include de-identified market pricing, benchmark data including Average Wholesale Price and Wholesaler Acquisition Cost, wholesaler information on market availability, and individual pharmacy feedback.
The synthesis of this information helps create a market based MAC price for generic items included on the MAC list. These sources are monitored and updates are used to help manage the market fluctuations of pricing on the MAC list. The MAC lists are reviewed on a monthly basis.