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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.

Prior Authorization Information for Your Patient’s Medicaid Pharmacy Benefit

Maximum Allowable Cost List Administration

UnitedHealthcare Community Plan works with OptumRx to manage the Pharmacy network. Multiple sources are used by OptumRx in order to assure the Maximum Allowable Cost (MAC) list accurately reflects market pricing and availability of generic drugs. Sources include de-identified market pricing, benchmark data including Average Wholesale Price (AWP) and Wholesaler Acquisition Cost (WAC), wholesaler information on market availability, and individual pharmacy feedback.

The synthesis of this information helps create a market based MAC price for generic items included on the MAC list. These sources are monitored and updates are used to help manage the market fluctuations of pricing on the MAC list.

MAC lists are reviewed twice weekly with additional updates implemented on an as-needed basis based on market forces and other additional information.

For Ohio Medicaid MAC inquiries, please contact OptumRx through email at medicaid_macappeal@optum.com.

If you believe a specific claim was paid incorrectly, please download this appeals form, and review the MAC appeals submissions guide for instructions.

If you have questions related to your contract with us or other issues related to the UnitedHealthcare Community Plan of Ohio Pharmacy Network, please feel free to contact our network relations line at 1-800-613-3591.

  • Email: pharmacycontracts@optum.com
  • For contracting Issues: 1-800-613-3591
  • Claims processing issues: 1-877-231-0131
  • Fax: 1-866-811-4224

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

See below for current pharmacy clinical guidelines and updates.

Visit the Policies and Clinical Guidelines page for more information. 

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.

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
  • For Makena or Vivitrol PH: 800-707-8194, Fax: 800-707-8217

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. 

UnitedHealthcare Community Plan of Ohio

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by the UnitedHealthcare Community Plan Program.

Preferred Drug List
Preferred Drug List Updates

UnitedHealthcare Connected for MyCare Ohio

The Preferred Drug List (PDL) is a list of prescription drugs considered coverable by the UnitedHealthcare Community Plan Program.

Preferred Drug List

Additional Pharmacy Resources