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
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.
- Nebraska Maximum Allowable Cost (MAC) Price Lookup
- Maximum Allowable Cost Appeal Submission Guide
- Maximum Allowable Cost List Administration
For general contract information, contact OptumRx at 1-800-797-9798.
Pharmacies with specific claim related questions should contact OptumRx at 1-866-328-3108.
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
- Medicated Assisted Treatment: Locate a Provider (Last Modified 10.01.2017)
- Naloxone Coverage for UnitedHealthcare Members (Last Modified 01.12.2018)
- Naloxone: What You Need to Know (Last Modified 11.15.2017)
- Opioid Tapering Recommendations (Last Modified 02.02.2018)
- The Role of Dentists in Managing Opioids (Last Modified 02.01.2018)
- Treatment Alternatives for Common Pain Conditions (Last Modified 02.08.2018
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
- Substance Abuse and Mental Health Services Administration (SAMHSA): The Role of Prevention in Addressing Neonatal Abstinence Syndrome
See below for current pharmacy clinical guidelines. Visit the Policies and Clinical Guidelines page for more information.
UnitedHealthcare Community Plan’s Clinical Pharmacy Program Guidelines are updated on an ongoing basis by our Pharmacy and Therapeutics Committee. Our changes reflect recent developments in pharmaceutical health care so we’re aligned with national treatment standards.
Rx Claims Processing Technical Assistance
Contact the OptumRx Help Desk at 877-231-0131. Support is available 24 hours a day, 7 days a week.
Pharmacy Prior Authorization Assistance
Contact our Pharmacy Prior Authorization line at 800-310-6826.
Medical Durable Medical Equipment (DME) Questions
Contact our Provider Service Center at 866-331-2243.
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.
If you would like to be contracted for DME services offered to UnitedHealthcare Community Plan - Heritage Health members, contact Sr. Network Account Manager Angela Hogan at:
Email : angela_hogan@uhc.com
Phone: 952-406-4955
Toll Free: 800-284-0626
Fax: 888-868-5011
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.
Network 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 pharmacy:
- BriovaRx 855-427-4682
Additional Specialty Pharmacies
The following specialty pharmacies also provide certain types of specialty medications:
- Accredo (Nursing Services) 800-803-2523
- Enzyme Deficiency
- Gaucher's Disease
- Immune Globulin
- Pulmonary Hypertension
- Option Care (Nursing Services) 866-827-8203
- Enzyme Deficiency
- Gaucher's Disease
- Hemophilia
- Immune Globulin
- Makena
- CVS Caremark Specialty Pharmacy 800-237-2767
- Pulmonary Hypertension
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.
UnitedHealthcare Community Plan of Nebraska
Preferred Drug List
The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by the Nebraska Department of Medicaid. The Preferred Drug List is produced by the state of Nebraska.
- Nebraska Preferred Drug List
- Pharmacy Preferred Drug List (PDL) Lookup Tool
- UnitedHealthcare Community Plan of Nebraska Preferred Drug List
Preferred Drug List Updates
Additional Pharmacy Resources
- Medication Quantity Limits (PDF, Last Modified 06.22.2018)
- OptumRx Pharmacy Manual - Review in conjunction with the Pharmacy Provider Manual.
- Step Therapy Policies