On Oct. 1, 2022, UnitedHealthcare Community Plan (Medicaid) moved to a single pharmacy benefits manager (PBM), Gainwell Technologies. Most pharmacies in Ohio are eligible. For more information, visit the Gainwell Ohio Medicaid page or call 833-491-0344.
View the current UnitedHealthcare Community Plan Reimbursement Policies.
We have compiled a list of evidence-based clinical guidelines and where they can be found for our quality and health management programs.
We respect the expertise of the physicians and other health care professionals in our network and appreciate your help as we work together to offer our members better quality, better health outcomes and better cost.
If you have questions, please contact your Physician Advocate or call the number on the back of the member’s ID card.
UnitedHealthcare has developed medical policies, medical benefit drug policies, coverage determination guidelines, and utilization review guidelines to assist us in administering health benefits. These policies and guidelines are provided for informational purposes and do not constitute medical advice.
For policy guidance for Medicare Advantage plan members, view the UnitedHealthcare Medicare Advantage Coverage Summaries and corresponding Policy Update Bulletins.