Hmm … it looks like your browser is out of date.
Let’s update your browser so you can enjoy a faster, more secure site experience.
UnitedHealthcare Connected® (Medicare-Medicaid Plan) Lookup Tools
Find a Provider
Find A Provider
Search our directory of network physicians and facilities.
2024 Provider/Pharmacy Directories
Find a Drug
Prescription Drug Transition Process
What to do if your current prescription drugs are not on the Drug List (formulary) or are restricted in some way
Drugs aren’t on list section
Sometimes, you may take a prescription drug that isn’t on your plan’s Drug List or it’s restricted in some way. Whether you’re a new member or a continuing member, there’s a way to get help.
Start by talking to your doctor. Your doctor can help decide if there’s another drug on the Drug List you can switch to. If there isn’t a good alternative drug, you, your representative or your doctor can ask for a formulary exception. If the exception is approved, you can keep getting your current drug for a certain period of time.
Review your Evidence of Coverage (EOC) to find out exactly what your plan covers. If you’re a continuing member, you’ll get an Annual Notice of Changes (ANOC). Review the ANOC carefully to find out if your current drugs will be covered the same way in the upcoming year.
Whether you’re switching drugs or waiting for an exception approval, you may be eligible for a transition supply of your current drug.
- You must get your 1-month supply, as described in EOC, during the first 90 days of membership with the plan as a new member OR within the first 90 days of the calendar year if you are a continuing member and your drug has encountered a negative formulary change.
- You may also be eligible for a one-time, temporary 1-month supply if you qualify for an emergency fill while residing in a long-term care (LTC) facility after the first 90 days as a new member or you have encountered a level of care change.
- If your doctor writes your prescription for fewer days and the prescription has refills, you may refill the drug until you’ve received at least a 1-month supply, as described in your EOC.
As a new plan member, you may currently be taking drugs that are not on the plan’s formulary (drug list), or they are on the formulary but are restricted in some way.
In instances like these, start by talking with your doctor about appropriate alternative medications available on the formulary. If no appropriate alternatives can be found, you or your doctor can request a formulary exception. If the exception is approved, you may be able to obtain the drug for a specified period of time.
During the first 90 days of your membership in the plan if you are a new member, you can request at least a 1-month supply, as described in your plan’s Evidence of Coverage.
During the first 90 days of the calendar year if you were in the plan last year and your drug encountered a negative formulary change, you can request at least a 1-month supply, as described in your plan’s Evidence of Coverage.
Members who have unplanned transitions such as hospital discharges (including psychiatric hospitals) or level of care changes (i.e., changing long-term care facilities, exiting and entering a long-term care facility, ending Part A coverage within a skilled nursing facility, or ending hospice coverage and reverting to Medicare coverage) at any time during the plan year. You can request at least a 1-month supply, as described in your plan’s Evidence of Coverage.
As a continuing member in the plan, you receive an Annual Notice of Changes (ANOC). You may notice that a drug you are currently taking is either not on the upcoming year’s formulary or is on the formulary but restricted in some way in the upcoming year.
Starting October 15, 2023, you may request a 2024 coverage review. If your request is approved, the plan will cover the drug as of January 1, 2024.
If your drug is subject to new formulary restrictions on January 1, 2024 and you have not discussed switching to an alternative formulary medication or pursued a formulary exception with your doctor, you may receive a temporary supply within the first 90 days of the new calendar year when you go to a network pharmacy. This would be at least a 1-month supply, as described in your plan’s Evidence of Coverage, to allow you time to discuss alternative treatment with your doctor or to pursue a formulary exception.
If you live in a long-term care facility, you can obtain multiple refills until you’ve reached at least a 31-day supply, including when prescriptions are dispensed for less than the written amount due to drug utilization edits that are based on approved product labeling.
There may be unplanned transitions such as hospital discharges or level of care changes (i.e., changing long-term care facility or in the week before or after a long-term care discharge, end of skilled nursing facility stay and reverting to Part D coverage or when taken off hospice care) that can occur anytime. If you are prescribed a drug that is not on our formulary or your ability to get your drugs is restricted in some way, you are required to use the plan's exception process. For most drugs, you may request a one-time temporary supply of at least one month, as described in your plan’s Evidence of Coverage, to allow you time to discuss alternative treatment with your doctor or to pursue a formulary exception.
For members who have been in the plan for more than 90 days and reside in a long-term care (LTC) facility and need a supply right away, we will cover at least a 31-day temporary supply, as described in your plan’s Evidence of Coverage.
If you have any questions about this transition policy or need help asking for a formulary exception, contact a member services representative.
For prescription drug transition process information in Spanish, go to Forms and Resources and view section 5.2 of your Evidence of Coverage (Spanish) for more information.
If you’re out of medication after receiving a temporary transition supply and you’re working with your prescriber to switch to an alternative drug or request an exception, call the number on your member ID card or contact UnitedHealthcare Customer Service.
The Coverage Determination Request Form may be found under Appeal a Coverage Decision section on this page.
Medication Therapy Management Program
UnitedHealthcare’s Medication Therapy Management (MTM) program was developed by a team of pharmacists and doctors. The MTM program provides members with a comprehensive medication review (CMR) with a pharmacist or other qualified health care provider. The program helps members understand their drug coverage and how to use their medications, and also educates members of potentially harmful drug interactions and/or risks of side effects.
- take eight (8) or more chronic Part D medications, and
- have three (3) or more long-term health conditions from the following list:
- Chronic obstructive pulmonary disease (COPD)
- Heart Failure
- High Cholesterol
- and are likely to spend more than $5,330 a year on covered Part D medications
- are in a Drug Management Program to help better manage and safely use medications such as those for pain.
What You Need to Do
Within 60 days of becoming eligible for the MTM program, you’ll receive an offer by mail to complete a Comprehensive Medication Review (CMR). You may also receive this offer by phone.
You can complete the CMR by phone or in person with a qualified health care provider. It takes about 30 minutes. A pharmacist, or qualified CMR provider, will review your medication history, including prescription and over-the-counter medications, and look for any issues.
Within 14 days of the CMR, you’ll receive a packet containing a summary of the review including action items discussed and a list of the medications you are taking and why you take them. This can be helpful when meeting with your doctor or pharmacist. The results may be sent to your doctor. In addition, members in the MTM program will receive information on the safe disposal of prescription medications including controlled substances.
You can also download a blank Medication List (PDF) for your own personal use.
In addition to the CMR, Targeted Medication Reviews are done at least quarterly. This is done to find any drug-drug interactions or other medication concerns. Those reviews will be sent to your doctor.
The Medication Therapy Management program isn’t a plan benefit. For more information on UnitedHealthcare’s Medication Therapy Management program, please call the number on the back of your plan member ID card or you may call the OptumRx MTM clinical call center team at 1-866-216-0198, TTY 711, Monday – Friday 9AM – 9PM EST.
Pharmacy Prior Authorization Request to OptumRx
Submit a Pharmacy Prior Authorization Request to OptumRx.
Pharmacy Direct Member Reimbursement Form
Find a Pharmacy
Click here for a list of pharmacies that deliver.
2024 Provider/Pharmacy Directories
This part of the Directory provides a list of pharmacies in UnitedHealthcare Connected® network. These network pharmacies are pharmacies that have agreed to provide prescription drugs to you as a member of the plan.
- UnitedHealthcare Connected® Members must use network pharmacies to get prescription drugs.
- You must use network pharmacies except in emergency or urgent care situations. If you go to an out-of-network pharmacy for prescriptions when it is not an emergency or urgent care situation, including when you are out of the service area, call UnitedHealthcare Connected® toll-free Member Services or 24-hour Nurse Advice Line for assistance in getting your prescription filled.
- If you go to an out-of-network pharmacy for prescriptions when it is not an emergency, you will have to pay out of pocket for the service. Read the UnitedHealthcare Connected® Member Handbook for more information.
- Some network pharmacies may not be listed in this Directory.
- Some network pharmacies may have been added or removed from our plan after this Directory was published.
For up to date information about UnitedHealthcare Connected® network pharmacies in your area, please visit our web site at www.UHCCommunityPlan.com or call Member Services at 1-800-256-6533, TTY users should call 711, 8 a.m. - 8 p.m., local time, Monday - Friday. The call is free.
To get a complete description of your prescription coverage, including how to fill your prescriptions, please read the Member Handbook and UnitedHealthcare Connected® List of Covered Drugs. You received the List of Covered Drugs in the mail when you became a member of this plan. You may also visit our web site at www.UHCCommunityPlan.com for the drug list.
Identifying Pharmacies in Our Network
Along with retail pharmacies, your plan’s network of pharmacies includes:
- Mail-Order Pharmacies
- Home infusion pharmacies
- Long-term care (LTC) pharmacies
You are not required to continue going to the same pharmacy to fill your prescriptions. You can go to any of the pharmacies in our network.
Mail Order Pharmacy(ies)
You can get prescription drugs shipped to your home through our network mail order delivery program which is called OptumRx® home delivery pharmacy. $0 copay may be restricted to particular tiers, preferred medications, or home delivery prescriptions during the initial coverage phase and may not apply during the coverage gap or catastrophic stage. Optum Rx is an affiliate of UnitedHealthcare Insurance Company. You are not required to use Optum Rx home delivery for a 90-100 day supply of your maintenance medication. Prescription orders sent directly from your doctor must have your approval before we can send your medications. This includes new prescriptions and prescriptions refills. We will contact you, by phone, to get your approval. If we are unable to reach you for approval, your prescription will not be sent to you.
You also have the choice to sign up for automated mail order delivery through our OptumRx® home delivery pharmacy. Typically, you should expect to get your prescription drugs from 4 to 6 days from the time that the mail order pharmacy gets the order.
If you do not get your prescription drug(s) within this time, if you would like to cancel an automatic order, or if you need to ask for a refund for prescriptions you got that you did not want or need, please contact us at 1-800-256-6533, TTY 711, 8a.m. - 8 p.m., local time, Monday - Friday.
Home Infusion Pharmacies
You can get home infusion therapy if UnitedHealthcare Connected® has approved your prescription for home infusion therapy and if you get your prescription from an authorized prescriber.
For more information, please see your Member Handbook, or call Member Services at 1-800-256-6533, TTY 711, 8 a.m. - 8 p.m., local time, Monday - Friday.
Long-Term Care Pharmacies
Residents of a long-term care facility, such as a nursing home, may access their prescription drugs covered under UnitedHealthcare Connected® through the facility’s pharmacy or another network pharmacy.
For more information, you can call Member Services at 1-800-256-6533, TTY 711, 8 a.m. - 8 p.m., local time, Monday - Friday.
Prescription orders sent directly from your doctor must have your approval before we can send your medications. This includes new prescriptions and prescriptions refills. We will contact you, by phone, to get your approval. If we are unable to reach you for approval, your prescription will not be sent to you.
UnitedHealthcare Connected® (Medicare-Medicaid Plan) H7833-001-000