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.
Additional COVID-19 Information and Resources
Additional COVID-19 Information and Resources are available including vaccine, testing, treatment, coding and reimbursement levels, telehealth services, prior authorization and ongoing patient care in addition to practice administration and credentialing and contracting processes.
- COVID-19 At Home Testing Billing Guidance New York Medicaid
- COVID-19 Information & Resources
- COVID-19 Oral Antiviral Emergency Use Authorization - For the Medical COVID-19 Treatment of Monoclonal Anitbodies - Effective December 29, 2021
- COVID-19 Therapeutic Dispensing or Administration Billing Guidance
- COVID-19 Vaccine Counseling Coverage
- For Pharmacies: OptumRx Coronavirus Vaccine Claims Submission for 3rd Dose Pfizer and Moderna
- For Pharmacies: New York Medicaid COVID-19 Testing Claims Submission
Find pharmacy information related to prescription drugs including prescription drug lists, step therapy, quantity limits and prior authorization requirements for Community Plan health 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
- Medicated Assisted Treatment: Locate a Provider
- Non-Opioid Alternatives
- Opioid Prescriber Reference Guide
- Opioid Tapering Recommendations
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
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 provided through various sources ‒ home infusion providers, outpatient facilities, physicians or specialty pharmacy.
Network Specialty Pharmacies
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:
- Optum Specialty Pharmacy: 855-427-4682
- Accredo: 800-803-2523
- Biologics: 800-850-4306
- Caremark Specialty Pharmacy: 800-237-2767
- Eversana: 800-305-7881
- Option Care Health: 866-827-8203
- Orsini Pharmaceutical Services: 800-410-8575
- PantheRx: 855-726-8479
- US Bioservices: 888-518-7246
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 Child Health Plus.
- UnitedHealthcare Community Plan Child Health Plus Preferred Drug List (PDL) Search
- UnitedHealthcare Community Plan Child Health Plus Preferred Drug List (PDL)
- Machine Readable PDL
Preferred Drug List Updates
- Preferred Drug List Update – January 1, 2022
- Preferred Drug List Update - July 1, 2021
- Preferred Drug List Update - January 1, 2021
- Preferred Drug List Update - October 1, 2020
90-Day Supply at Retail
Preferred Drug List
The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by Essential Plan.
- United Healthcare Community Plan Essential Plan 1 - Preferred Drug List (PDL) Search
- United Healthcare Community Plan Essential Plan 2 - Preferred Drug List (PDL) Search
- United Healthcare Community Plan Essential Plan 3 - Preferred Drug List (PDL) Search
- United Healthcare Community Plan Essential Plan 4 - Preferred Drug List (PDL) Search
- UnitedHealthcare Community Plan New York Essential Plan Preferred Drug List (PDL)
- Machine Readable PDL
Preferred Drug List Updates
Preferred Drug List
The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by UnitedHealthcare Community Plan.
- UnitedHealthcare Community Plan of New York Preferred Drug List (PDL) Search
- UnitedHealthcare Community Plan of New York Preferred Drug List (PDL)
- Machine Readable PDL
Preferred Drug List Updates
- Preferred Drug List Update – January 1, 2022
- Preferred Drug List Update - July 1, 2021
- Preferred Drug List Update - January 1, 2021
- Preferred Drug List Update - October 1, 2020
90-Day Supply at Retail
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).
Preferred Drug List
The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by UnitedHealthcare Wellness4Me.
- UnitedHealthcare Community Plan Wellness4Me Preferred Drug List (PDL) Search
- UnitedHealthcare Community Plan Wellness4Me Preferred Drug List (PDL)
- Machine Readable PDL
Preferred Drug List Updates
- Preferred Drug List Update – January 1, 2022
- Preferred Drug List Update - July 1, 2021
- Preferred Drug List Update - January 1, 2021
- Preferred Drug List Update - October 1, 2020
90-Day Supply at Retail
Additional Pharmacy Resources
- OptumRx Pharmacy Manual - Review in conjunction with the Pharmacy Provider Manual
- Update Effective March 22, 2022: Single Statewide Formulary for Opioid Dependence Agents and Opioid Antagonists for both Medicaid Managed Care Plans and Fee-For-Service
- Synagis Enrollment Form
- Synagis Dosing and Prior Authorization Process