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2023 Information

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2023 Provider/Pharmacy Directories

2023 Formularies

Prescription Drug Transition Process

What to do if your current prescription drugs are not on the formulary or are limited on the formulary.

New Nembers
As a new member of UnitedHealthcare Connected® , insured through UnitedHealthcare, you may currently be taking drugs that are not on the UnitedHealthcare® formulary (drug list), or they are on the formulary but your ability to get them is limited.

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 will be able to obtain the drug for a specified period of time. While you and your doctor are determining your course of action, you may be eligible to receive an initial 31-day transition supply (unless your prescription is written for fewer days) of the drug anytime during the first 90 days you are a plan member.

For each of your drugs that is not on the formulary or if your ability to get your drugs is limited, UnitedHealthcare will cover a 31-day supply (unless your prescription is for fewer days) when you go to a network pharmacy. If the prescription is written for less than 31 days, multiple fills are allowed to provide up to a total of 31 days of drugs. After your first 31-day transition supply, these drugs may not continue to be covered. Talk with your doctor about appropriate alternative medications. If there are none on the formulary, you or your doctor can request a formulary exception.

If you live in a long-term care facility, UnitedHealthcare will cover a temporary 31-day transition supply (unless your prescription is for fewer days). UnitedHealthcare will cover more than one refill of these drugs for the first 90 days for plan members, up to a 93-day supply. If you need a drug that is not on the formulary or your ability to get your drugs is limited, but you are past the first 90 days of plan membership, the transition program will cover a 31-day emergency supply of that drug (unless your prescription is for fewer days) while you pursue a formulary exception.

You may face unplanned transitions after the first 90 days of plan enrollment, such as hospital discharges or level of care changes (i.e., in the week before a long-term care discharge), If you are prescribed a drug that is not on the formulary or your ability to get your drugs is limited, you are required to use the plan's exception process. You can request a one-time emergency supply of up to 31 days to allow you time to discuss alternative treatment with your doctor or to pursue a formulary exception.

Continuing Members
As a continuing member in the plan, you receive an Annual Notice of Changes (ANOC). You may notice that a formulary medication you are currently taking is either not on the upcoming year's formulary or its cost sharing or coverage is limited in the upcoming year.

For coverage requests received each year by December 15, and approved, the plan will cover the drug as of January 1. For coverage requests initiated on or after December 16, normal time frames for resolution apply: you will receive an answer within 24 hours for urgent requests and within 72 hours for all other requests. If your request is still in process on January 1, you may receive a temporary supply of the drug for your current plan cost-sharing until your request is answered.

If you have any questions about this transition policy or need help asking for a formulary exception, a UnitedHealthcare representative can help.

Related Information
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.

How to Qualify
What You Need to Do
What's Next

How to Qualify
This program is available at no additional cost. You’ll be automatically enrolled in the Medication Therapy Management program if you:

  • 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)
    • Diabetes
    • Heart Failure
    • High Cholesterol
    • Osteoporosis
  • and are likely to spend more than $4,935 a year on covered Part D medications

OR

  • 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.

What's Next
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.

Prior Authorizations

Prior Authorization Request 

Download the Prescription Prior Authorization List (Coming Soon)

Pharmacy Prior Authorization Request to OptumRx

Submit a Pharmacy Prior Authorization Request to OptumRx.

Pharmacy Direct Member Reimbursement Form

Download a MAPD Prescription Reimbursement Request Form from OptumRx.

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Pharmacy Delivery

Click here for a list of pharmacies that deliver.

2023 Provider/Pharmacy Directories

Pharmacies
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.called OptumRx® home delivery pharmacy.

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.

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UnitedHealthcare Connected® (Medicare-Medicaid Plan)  H7833-001-000

TX UnitedHealthcare Connected® (Medicare-Medicaid Plan)
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ATTENTION: If you speak an alternative language, language assistance services, free of charge, are available to you. Call the Member Engagement Center 1-800-256-6533 (TTY 711) , 8 a.m. - 8 p.m., local time, 7 days a week. The call is free.

ATENCIÓN: Si habla español, tiene a su disposición servicios de asistencia gratuitos en su idioma. Llame al Centro de participación de miembros/a Servicio al Cliente al 1-800-256-6533 (TTY 711), de 8 a.m. a 8 p.m., hora local, los 7 días de la semana. La llamada es gratuita.

ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele Sant Angajman Manm/Sèvis Manm nan 1-800-256-6533 (TTY 711), 8 a.m. - 8 p.m., lè lokal, 7 jou sou sèt. Apèl la gratis.

សម្គាល់៖ ប្រសិនបើលោកអ្នកនិយាយភាសាខ្មែរ លោកអ្នកអាចរកបានសេវាកម្មជំនួយផ្នែកភាសាដោយឥតគិតថ្លៃបាន។

ទូរសព្ទទៅមជ្ឈមណ្ឌលចូលរួមជាមួយសមាជិក/សេវាកម្មសមាជិក  1-800-256-6533 (TTY 711), 8 ព្រឹក - 8 យប់ ម៉ោងក្នុងមូលដ្ឋាន 7 ថ្ងៃក្នុងមួយសប្ដាហ៍។ ការហៅទូរស័ព្ទគឺឥតគិតថ្ល។]

ເຊີນຊາບ: ຖ້າທ່ານເວົ້າ ພາສາລາວ, ພວກເຮົາມີບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາໂດຍບໍ່ຕ້ອງເສຍຄ່າໃດໆໃຫ້ແກ່ທ່ານ. ໂທຫາສູນຕິດຕໍ່ພົວພັນສະມາຊິກ/ຝ່າຍບໍລິການສະມາຊິກ 1-800-256-6533 (TTY 711), 8 ໂມງເຊົ້າ - 8 ໂມງແລງ, ຕາມເວລາທ້ອງຖິ່ນ, 7 ວັນຕໍ່ອາທິດ. ການໂທແມ່ນບໍ່ເສຍຄ່າ.

ATENÇÃO: Se fala português, é-lhe disponibilizado um serviço gratuito de assistência linguística. Telefone para o Centro de Conexão dos Associados/Serviços de Atendimento a Associados 1-800-256-6533 (TTY 711), 8h00 - 20h00, hora local, 7 dias por semana. A chamada é gratuita.

ВНИМАНИЕ! Если Вы говорите по-русски, можете бесплатно воспользоваться помощью переводчика. Звоните в центр взаимодействия с участниками/отдел обслуживания участников по номеру телефона 1-800-256-6533 (TTY 711), 8:00 - 20:00 по местному времени, без праздничных и выходных. Звонок бесплатный.

LƯU Ý: Nếu quý vị nói tiếng Việt, chúng tôi có dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho quý vị. Xin gọi cho Trung tâm Tham gia Hội viên/Dịch vụ Hội viên 1-800-256-6533 (TTY 711), 8 a.m. - 8 p.m., giờ địa phương, 7 ngày trong tuần. Cuộc gọi này là miễn phí.][注意：如果您说中文，您可以获得免费语言帮助服务。致电会员服务中心/会员服务 1-800-256-6533 (TTY 7-1-1)，听障专线当地时间<上午 8 点 - 晚上 8 点>，每周 <7> 天。该通话是免费的。

Potential for Contract Termination

How to end your membership in our plan

If you decide to end your membership, tell Texas Medicaid or Medicare that you want to leave UnitedHealthcare Connected®:

•Call MAXIMUS at 1-877-782-6440, 8 a.m. – 6 p.m. local time, Monday – Friday. TTY/TDD users should call 7-1-1 or 1-800-735-2989; OR

•Send MAXIMUS an Enrollment Change Form. You can get the form by calling MAXIMUS at 1-877-782-6440 (TTY 711 or 1-800-735-2989) if you need them to mail you one; OR

•Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users (people who have difficulty hearing, or speaking) should call 1-877-486-2048. When you call 1-800-MEDICARE, you can also enroll in another Medicare health or drug plan. More information on getting your Medicare services when you leave our plan is in the chart on page 214 of your EOC/Member Handbook.

Other situations when your membership ends

These are the cases when UnitedHealthcare Connected® must end your membership in the plan:

  • If there is a break in your Medicare Part A and Part B coverage.
  • If you no longer qualify for Texas Medicaid. Our plan is for people who qualify for both Medicare and Texas Medicaid.

Last Updated: 04.13.2023 at 03:07 PM CDT

H7833_230110_051300 Approved

Disclaimer Information
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Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

UnitedHealthcare Dual Complete plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Premium Disclaimer

Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).

Nurse Hotline disclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your provider's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time. Nurse Hotline not for use in emergencies, for informational purposes only.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® (Medicare-Medicaid Plan)

UnitedHealthcare Connected® (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® for One Care (Medicare-Medicaid Plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® general benefit disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. 

UnitedHealthcare Senior Care Options (HMO SNP) Plan

UnitedHealthcare Senior Care Options (SCO) is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare and does not have any other comprehensive health Insurance, except Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our Senior Care Options (SCO) program.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system. The 5 Star rating applies to plan year 2023.

Important provider information

The Choice is Yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non- contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Inaccurate information

To report incorrect information, email provider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UnitedHealthcare Members should call the number on the back of their ID card, and non-UnitedHealthcare members can call 1-888-638-6613 TTY 711, or use your preferred relay service.

Declaration of Disaster or Emergency

If you’re affected by a disaster or emergency declaration by the President or a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non- contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.