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 and non-clinical policies (ex. Denied Drug Codes – Pharmacy Benefit Drugs) for Physician Administered Drugs/Medical Injectables are available at Policies and Protocols > Community Plan Policies > Medical & Drug Policies and Coverage Determination Guidelines.
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.
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.