To help address current shortages of drugs that are covered by our plans, we’ve updated our Prescription Drug Lists (PDLs) for all plans to temporarily cover some therapeutic equivalent and alternative medications to ensure member access while the covered drugs are in short supply.
Enroll in Emailing Clinical Information for Pharmacy Appeal - Medicare
UnitedHealthcare now offers the option to enroll in emailing clinical information for prior authorization and appeal requests for Medicare pharmacy claims. This process will allow you to send and receive clinical documents in a secure, HIPAA-compliant, electronic environment, allowing you more time with your patients and less time on paperwork.
UnitedHealthcare’s Step Therapy program helps encourage use of less expensive, but similarly effective medications. Members must try a lower-cost medication (known as step 1) before progressing to a higher-cost alternative (known as step 2).
UnitedHealthcare is confronting the opioid epidemic from all angles. We’re joining with care providers and communities to prevent opioid misuse and addiction. Through touch points, we help support safe and appropriate opioid use right from the start.
To help with this effort, we developed the following UnitedHealthcare pharmacy-based programs to align with The Centers for Medicare and Medicaid Services (CMS) Medicare Part D Opioid Overutilization Policy.
These programs are specific to UnitedHealthcare Medicare Advantage and Prescription Drug Plans.
At Optum® Infusion Pharmacy, our pharmacists, nurses, patient care coordinators and benefits experts deliver full-service acute and chronic specialty infusion care, so you and your patients can focus on treatment, not obstacles.
Top five reasons to refer to Optum Infusion Pharmacy
1. Patient access, safety, convenience and care
We offer home infusion and are adding infusion pharmacy locations, services and nationwide. Choose the most convenient setting for each patient’s medication and dose regimen, whether it’s home infusion or an infusion suite with a reclining chair, television and free Wi-Fi.
Our nurses and infusion staff are specially trained in infusion care.
<0.5% of patients have an adverse event or an unplanned hospitalization due to an infection, adverse drug reaction, vein trauma or other treatment complication.1
2. Proactive service
We help resolve insurance denials, geographical challenges, cost concerns and more, so that treatment can continue uninterrupted. We’re in-network for most major insurance carriers, and our site-specific teams are experts in regional insurance requirements.
Our experienced appeals team, made up mostly of nurses, overturns 8 out of 10 insurance denials.2
3. Clinical expertise, personalized care
Our pharmacists ensure safe, seamless care whether treatment is administered by a nurse or patients themselves. Disease-specific nurses empower patients and caregivers by educating them on the condition, treatment, self-administration if applicable, and more.
4. Patient comfort and resources
For patients who use home infusion, we ship and, if needed, hand-deliver medication, supplies and instructions to their home. Patients have access to disease-specific education, video libraries of others’ treatment experiences, and 24/7 face-to-face video consultations with a disease-expert clinician.
5. Frequent sales team communication
We stay in direct contact with you while we monitor labs, tolerance, adherence and clinical status throughout treatment.
UnitedHealthcare makes pharmacy coverage decisions based on an understanding of how our coverage affects total health care. We do this by integrating pharmacy coverage with medical management, accessing information in a database including pharmacy, medical and laboratory data.
Pharmacy is one of the most highly used benefits. Our goal is to provide members with wide-ranging, cost-effective medication choices. We review clinical and pharmacoeconomic evidence when developing our prescription drug list (PDL) and clinical programs. This evidence helps us determine a medication's overall value relative to other medications in its class so we can effectively manage overall cost and care.
Our personalized member engagement strategies aim to make health care work better for members. When provided with the right resources, a member can be empowered to discuss their options with their care providers and help make more educated decisions.
NOTE: The information on this website is intended to provide general pharmacy information for care providers. The information on this site is NOT specific to a member’s benefit plan.