Community Plan Prior Authorization Guidelines for Prescribers
Requesting prior authorization electronically saves time and reduces potential prescription interpretation errors. Authorization determination can be immediate but generally takes no more than 24 hours. You can use the following resources for help with your request:
CoverMyMeds streamlines the pharmacy prior authorization process by electronically connecting providers and pharmacists to improve time to therapy and decrease prescription abandonment.
Integrated directly with your EMR, PreCheck MyScript® allows you to easily run a pharmacy trial claim and get real-time prescription coverage details for your patients who are UnitedHealthcare benefit plan members.
When supporting documentation is necessary to determine medical necessity in a prior authorization review, the forms below should be faxed to 866-940-7328.
Use a drug-specific form if available. Otherwise, you can use the Texas Department of Insurance form for any prescription prior authorization request.
The response time for authorization determination with complete documentation is within 24 hours. It may take up to three days to receive a determination for members in the Children’s Health Insurance Program (CHIP).
If a pharmacist is unable to confirm a prior authorization for a medication that requires an authorization and the drug needs to be given without delay for the health of the member, a 72-hour supply can be dispensed. An authorization will need to later be initiated and obtained by the prescribing provider.
At UnitedHealthcare we've 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
- Opioid Prescriber Reference Guide (Last Modified 08.27.2020)
Need More Help?
If you have questions, please call our Pharmacy Help Desk at 800-310-6826. You can get answers to prescription questions and an immediate determination for a prior authorization 24 hours a day, seven days a week.