Find pharmacy information related to prescription drugs including prescription drug lists, step therapy, quantity limits and prior authorization requirements for Community Plan care providers.
Effective July 1, 2021, the North Carolina Department for Medicaid Services requires UnitedHealthcare Community Plan to follow the North Carolina Fee-For-Service PDL and Clinical Criteria. Additional pharmacy benefit and medication information can be found below in this section to assist our providers.
North Carolina Pharmacy Services Clinical Coverage Policies can be found in the Clinical Pharmacy Guidelines
For submission of a prior authorization for a UnitedHealthcare Community Plan of North Carolina Member:
Prior Authorization Requests - Prescribers may submit prior authorizations for Community Plan Members:
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
All pharmacy providers shown are contracted for both Medicaid and Health Choices.
For submission of a prior authorization for a UnitedHealthcare Community Plan of North Carolina:
Prior Authorization Requests - Prescribers may submit prior authorizations for Community Plan Members:
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.
The PreCheck MyScript Solution 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.
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.
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.
To see the latest PDL updates, visit Drug Lists and Pharmacy > UnitedHealthcare Prescription Drug Lists (PDL) / Drug Formulary > Prescription Drug List Updates.