Pharmacy Resources and Physician Administered Drugs
Find pharmacy information related to prescription drugs including prescription drug lists, step therapy, quantity limits and prior authorization requirements for Community Plan care providers.
Clinical Pharmacy Guidelines and Policies
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.
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:
By calling 855-258-1593 or by fax at 866-940-7328
Online at uhcprovider.com > Sign In (top right) > sign in with your One Healthcare ID > Prior Authorization & Notification application
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.
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.
Physician Administered Drugs / Medical Injectables / Specialty Pharmacy
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.