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Pharmacy Resources and Physician Administered Drugs

COVID-19 NY State PPE Fee Guidance

The New York State Department of Financial Services (DFS) recently issued guidance stating that care providers should not charge members additional fees for items such as personal protective equipment (PPE). DFS expects New York care providers to refund any of these charges paid by the member that were more than the member’s financial responsibility on a claim. If you have questions, please contact your provider advocate or network management contact. Thank you.

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

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

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.

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.

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. 

Prescription Drug Lists / Formulary Lists, Drug Search and Updates

Preferred Drug List

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by UnitedHealthcare Dual Advantage. 

Preferred Drug List

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by UnitedHealthcare Dual Complete (HMO SNP). 

 

Additional Pharmacy Resources