United Healthcare Community Plan formulary

Providers who wishes to assist their particular UnitedHealthcare Community Arrange customers with finding nearby open pharmacies in areas influenced by catastrophe, kindly reference the next organizations.

Medical Prepared at: Healthcare Eager.org

Louisiana Independent Pharmacies Association at: lipanow.org

For additional drugstore information please contact client services at: 866-675-1607

Preferred Drug List (PDL) Search
Preferred Drug List (PDF 983.07 KB)
Healthy Louisiana Common PDL (PDF 444.8 KB)

1/1/2017 PDL Upgrade (PDF 157.62 KB)
10/1/2016 PDL Upgrade (PDF 69.14 KB)
8/1/2016 PDL Improve (PDF 67.71 KB)
5/1/2016 PDL Improve (PDF 62.88 KB)

Essential Action Treatment Information
Step Treatment Policy (PDF 21.02 KB)

Amount Limit Initiatives
Quantity Limit Policy (PDF 20.11 KB)

Pharmacy Bulletins

Louisiana Practitioner Bulletin Q4 2015 Improve (PDF 61.62 KB)
Synagis Enrollment Form (PDF 511.58 KB)
Synagis Program (PDF 53.22 KB)
Synagis System 5 Doses (PDF 42.79 KB)

Drugstore Prior Authorization Types

Optimal Allowable Cost List Administration

UnitedHealthcare Community Plan works together OptumRx to control the Pharmacy community. Several resources are employed by OptumRx so that you can assure the Maximum Allowable price (MAC) number precisely reflects market pricing and accessibility to generic medications. Resources consist of de-identified market pricing, benchmark information including typical Wholesale Price (AWP) and Wholesaler purchase Cost (WAC), wholesaler home elevators market accessibility, and individual drugstore comments.

The formation of this information assists create a market based MAC price for generic products included from the MAC record. These sources tend to be supervised and updates are accustomed to assist manage the marketplace changes of pricing regarding the MAC list. The MAC lists tend to be assessed from month to month.

MAC cost Lookup: A contracted pharmacy may access MAC prices here:

Pharmacy and Therapeutics Committee:

2017 Committee conference dates:

Specialty drugstore medications covered in the Medical Benefit might be provided through a variety of networks – home infusion supplier, outpatient facility, doctor, or niche drugstore.

For doctors that do not require to buy-and-bill a specialty pharmacy medication this is certainly covered on the Medical advantage, they may decide to supply it through a system niche pharmacy:

These specialty pharmacies may also provide particular categories of specialty pharmacy medications:

Coverage regarding the required medicine is based on the member’s advantages, and accessibility to a particular medication from a system specialty pharmacy can vary greatly.

The Specialty Pharmacy can deliver the medicine on medical practitioner’s office or another site (ex. patient’s house) upon request, therefore the Specialty Pharmacy will bill the patient’s wellness plan directly.

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