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.
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.