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
- 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)
- Opioid Use Disorder (Last Modified 03.05.2019)
- 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
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.
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)
Preferred Drug List Updates
- Preferred Drug List Update - April 1, 2019
- Preferred Drug List Update - January 1, 2019
- Preferred Drug List Update - October 1, 2018
- Preferred Drug List Update - July 1, 2018
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)
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)
Preferred Drug List Updates
- Preferred Drug List Update - April 1, 2019
- Preferred Drug List Update - January 1, 2019
- Preferred Drug List Update - October 1, 2018
- Preferred Drug List Update - July 1, 2018
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).
Pharmacy Benefits
- New York City: Effective Oct. 1, 2015
- Rest of New York State: Effective July 1, 2016
View the New York Health and Recovery Plan (HARP) Pharmacy Benefits.
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)
90-Day Supply at Retail
Additional Pharmacy Resources
- OptumRx Pharmacy Manual - Review in conjunction with the Pharmacy Provider Manual.
- Pharmacies-Vaccine Billing and Flu Vaccine List 2018-2019
- Step Therapy Policies
- Synagis Enrollment Form (Last Modified 06.22.2018)
- Synagis Dosing and Prior Authorization Process