Florida Medicaid Pharmacy Help Desk

Pharmacy Resources And Physician Administered Drugs

Find pharmacy information related to prescription drugs including prescription drug lists, step therapy, quantity limits and prior authorization requirements for Community Plan care providers.

In response to the U.S. opioid epidemic, UnitedHealthcare has developed programs to help our members receive the care and treatment they need safely and effectively.

Weve also established measures based on the Centers for Disease Control and Preventions opioid treatment guidelines to help prevent overuse of short-acting and long-acting opioid medications.

For Members Without Medicare Coverage:

Getting My Medicine

If you are a member with no Medicare coverage, please for the Prescription Drug List for the Medicaid Managed Medical Assistance Program.

FCC uses a Preferred Drug List . The PDL is a list of drugs that we prefer your doctor use. The Florida Medicaid PDL is subject to revision following consideration and recommendations by the Pharmaceutical and Therapeutics Committee and the Agency for Health Care Administration . Medications on the PDL are organized by the therapeutic classification and includes brand and generic name along with any age limits and clinical prior authorization requirements. Please refer to the separate Summary of Limitations document for important information regarding quantity and/or age limits for applicable drugs.

We cover brand name and generic drugs. Generic drugs have the same ingredients as brand name drugs, but they are often cheaper than brand name drugs. They work the same. Sometimes, we may cover brand name drugs even if a generic is available.

The list of covered drugs may change from time to time, but we will let you know if anything changes. You can work with your doctor to ensure use of medications on the PDL or request prior authorizations for medications on the PDL with restrictions or not included on the PDL.

You may be taking a drug that is no longer on our PDL. Your doctor can ask us to keep paying for this drug by requesting a prior approval. The drug must be safe and help you with your medical problem.

Pharmacy Utilization Management Programs

• Responsible Quantity Responsible Quantity is an initiative to ensure that prescription drug coverage reflects drug manufacturers’ and FDA dosing guidelines.
• Quantity Limit Authorization Form Authorization requests for use of over 4,000 mg of acetaminophen per day cannot be approved.

To request a prior authorization for a medication included in the Responsible Quantity program, download the Quantity Limit Authorization form, complete and fax to 1-877-480-8130.

You can also use CoverMyMeds to request authorization.

• Responsible Steps Responsible Steps is an initiative to ensure the use of a designated or prerequisite drug prior to providing coverage of the drug listed as a target in the program.

To request a prior authorization for a medication included in the Step Therapy program, download the appropriate Step Therapy Prior Authorization Request form, complete and fax to 1-877-480-8130.

You can also use CoverMyMeds to request authorization.

• Prior Authorization Prior Authorization assures that specific clinical criteria are met in order for coverage of the drug included in the Prior Authorization program.

To request a prior authorization for a medication included in this program, download the appropriate form, complete and fax to the number at the bottom of the form.

You can also use CoverMyMeds to request authorization.

• Medications Not Covered

Your pharmacy benefit may not cover select medications. Some of the reasons a medication may not be covered are:

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Medication Guides For Medicare Eligibles

The Medication Guides are updated monthly. Links are included below to the Medicare approved Formularies and the most recent updates to the printed version of the Medication Guide for Medicare Eligibles.

• BlueMedicare Plan Information

Please have your patient refer to the pharmacy endorsement or rider issued with his or her contract, Evidence of Coverage, member handbook or certificate of coverage to determine whether a particular medication listed is covered. If your patient is unsure about particular coverage/benefits or has questions about the Medication Guide, please have the member call the Customer Service number on his or her ID card. The fact that a particular drug is listed in the guide does not necessarily mean that it is covered under each member’s contract, Evidence of Coverage or certificate of coverage.

1If you are not sure if your group is a small-group or large-group, please ask your HR administrator.

Do You Have A Question Comment Or Suggestion

If so, we want to hear from you.

Wellcare Medicare Duals Special Needs Plans1-833-444-9089 October 1 – March 31: MondaySunday, 8 a.m. to 8 p.m.April 1 – September 30: MondayFriday, 8 a.m. to 8 p.m.

Prospective Medicare Members

Monday – Sunday, 8 a.m. to 8 p.m.

Wellcare Medicare Duals Special Needs Plans1-866-527-0056 Monday – Sunday, 8 a.m. to 8 p.m.

Current Prescription Drug Plan Members

Wellcare Classic, Value Script and Medicare Rx Value Plus1-888-550-5252 October 1 – March 31: Monday – Sunday, 8 a.m. to 8 p.m.April 1 – September 30: Monday – Friday, 8 a.m. to 8 p.m.

Prospective Prescription Drug Plan Members

Wellcare Classic, Value Script and Medicare Rx Value Plus1-888-293-5151 Monday – Sunday, 8 a.m. to 8 p.m.

Chat with a Member Services Agent.

Providers

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Resources From Unitedhealthcare And Optum

• Community Plan M*Plus Prior Authorization Drug Criteria

Streamline your prior authorization process with CoverMyMeds

CoverMyMeds streamlines the medication prior authorization process, electronically connecting providers, pharmacists and plan/PBMs to improve time to therapy and decrease prescription abandonment with electronic prior authorization.

Get real-time prescription costs and coverage detail

The PreCheck MyScript Solution on Link helps make it easy to run a pharmacy trial claim and get real-time prescription coverage detail for your patients who are UnitedHealthcare benefit plan members.

Specialty medications can be covered under the pharmacy benefit, the medical benefit or both benefits, depending on the benefit structure for the members coverage.

Pharmacy benefit medications are typically self-administered by the patient or a caregiver, after filling the prescription through a pharmacy. These medications are labeled for self-administration by the Food and Drug Administration but may require some instruction to the patient or caregiver.

Typically, medications administered orally, topically or through subcutaneous injection by the patient or a caregiver after receiving instruction are covered under the pharmacy benefit.

Coverage of a requested medication depends on the members Medicaid coverage as determined by the State Medicaid agency, and the availability of a specific drug from a network specialty pharmacy may vary.

Specialty Program Description

Implementation Of Section 121 Of The Consolidated Appropriations Act Of 2022

The Consolidated Appropriations Act of 2022 was signed into law on March 15, 2022. Section 121 of the law permits certain hospitals to be reinstated into the 340B Drug Pricing Program if they meet the following conditions:

• The hospital must be classified as a:
• Disproportionate share hospital,
• Children’s hospital, or
• Free standing cancer hospital.

If you believe that your hospital may be eligible for this exception and have not yet been contacted by HRSA, please contact the 340B Prime Vendor at or . Requests will be evaluated on a case-by-case basis.

Also Check: Florida Medicaid Provider Portal Registration

Covid 19 Test Kit Reimbursement Request Form

• PDF 67.59KB – Last Updated: 07/11/2022

Direct Member Reimbursement

If you receive a drug at an out-of-network pharmacy, the out-of-network pharmacy will not have the needed information to bill your drug to us. Under certain circumstances, such as an out-of-area emergency, you may be reimbursed for your medication. You will need to pay for the drug and then complete a Direct Member Reimbursement form to be reimbursed for the cost of the drug.

• PDF 97.41KB – Last Updated: 11/12/2020

Fl Medicaid Mma Preferred Drug List

• CCP has adopted the current Medicaid Preferred Drug List for CCPs FL Medicaid MMA enrollees. For Further information on drug coverage,
• For information on the FL Medicaid Preferred Drug Program,
• For prior authorization forms for FL Medicaid MMA enrollees,
• For additional Drug Criteria requirements for FL Medicaid MMA enrollees,

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Welcome To Nyrx The Medicaid Pharmacy Program

The New York State Medicaid Pharmacy program, NYRx, covers medically necessary FDA approved prescription and non-prescription drugs for Medicaid members. Prescription drugs require a prescription order with appropriate required information. Non-prescription drugs, often referred to as Over-the-Counter or OTC drugs, require a fiscal order . Certain drugs/drug categories require the prescribers to obtain prior authorization. Information on this benefit can be found in the New York State Medicaid State Plan Amendment.

Beginning April 1, 2023, Medicaid members enrolled in mainstream Managed Care plans, Health and Recovery Plans , and HIV-Special Needs Plans will have their pharmacy benefits transitioned to NYRx, the Medicaid Pharmacy program. The transition will not apply to members enrolled in Managed Long-Term Care plans , the Essential Plan, or Child Health Plus.

Pharmacy program and billing policy and other pharmacy related information can be found in the NYS MMIS Pharmacy Provider Manual and the Department’s Medicaid Update. You may also contact us at or 486-3209 for Medicaid pharmacy policy related questions.

For more information and copies of letters sent to pharmacists and prescribers, please see Pharmacy Provider Communications below.

The following information may be of interest to pharmacists and prescribers:

Introducing Centerwell Pharmacy And Centerwell Specialty Pharmacy

As of June 11, 2022, Humana Pharmacy® and Humana Specialty Pharmacy® will become CenterWell Pharmacy and CenterWell Specialty Pharmacy, respectively. PrescribeIT Rx Pharmacy also is becoming CenterWell Pharmacy. Our new name reflects our commitment to putting you at the center of everything we do. Best of all, theres nothing for you to do.

Youll continue getting your medication on time as you did before. Well also let your doctors know.

To learn more about CenterWell Specialty Pharmacy

• Call 800-486-2668 , Monday Friday, 8 a.m. 8 p.m., and Saturday, 8 a.m. to 6 p.m., Eastern time

To learn more about CenterWell Pharmacy, formerly PrescribeIT Rx:

• Call 800-526-1490 , Monday Friday, 8 a.m. 6 p.m., Eastern time

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Public Health Emergency Declaration By The Secretary

We recognize that circumstances surrounding disaster relief efforts warrant flexibility for entities eligible for participation in the 340B Program.

Therefore, eligible entities in South Carolina, Florida, New Mexico, Puerto Rico, and Kentucky may immediately enroll for the 340B Program during the Public Health Emergency Declaration by the Secretary, rather than having to wait for the normal quarterly registration period.

We believe this will enable these entities to meet the needs of the residents affected by this disaster.

Contact: If you are in the listed states/territories and would like to enroll, or call 1-888-340-2787.

The 340B Program enables covered entities to stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.

Manufacturers participating in Medicaid agree to provide outpatient drugs to covered entities at significantly reduced prices.

Eligible health care organizations/covered entities are defined in statute and include HRSA-supported health centers and look-alikes, Ryan White clinics and State AIDS Drug Assistance programs, Medicare/Medicaid Disproportionate Share Hospitals, childrens hospitals, and other safety net providers. See the full list of eligible organizations/covered entities.

Unitedhealthcare Senior Care Options Plan

UnitedHealthcare 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 plans 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. 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 SCO program.

Read Also: Humana Medicaid Long Term Care

Unitedhealthcare Community Plan Medicaid Lookup Tools

Search for a Provider

Choosing a Plan to Search for a Provider

From the drop down list choose the Plan name that matches the name in the lower right corner of your UnitedHealthcare ID Card:

M*Plus – MMA Medicaid Benefits Only with UnitedHealthcare

Health & Home Connection – Long Term Care Benefits Only with UnitedHealthcare

M*Plus Connection – Both MMA and LTC Benefits with UnitedHealthcare

• Please note: M*Plus Connection Members can search for Medicaid providers by choosing M*Plus and for LTC providers by choosing Health & Home Connection when doing a provider search.

• PDF 104.15KB – Last Updated: 11/12/2020

Unitedhealthcare Connected For Mycare Ohio

UnitedHealthcare Connected® for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.

Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .

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. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

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Health Care Coverage For Members With Florida Medicaid

FL Medicaid MMA Pharmacy Locator

To locate a pharmacy,

FL Medicaid MMA- Magellan Customer Service

For questions regarding your prescriptions, contact Magellan Help Desk,

FL Medicaid MMA Magellan Specialty Pharmacy

For questions regarding your specialty prescriptions, contact Magellan Help Desk,

FL Medicaid MMA Preferred Drug List

CCP has adopted the current Medicaid Preferred Drug List. Further information on drug coverage can be found here.

FL Medicaid MMA Pharmacy Member Portal

This safe site tells you about what drugs are covered. You can see your medicines you filled. You can find drug stores that are in our network and near you. There are even tools to help you live a healthier life.

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 plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

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Statement From The Health Resources And Services Administration Regarding Recent Court Rulings Involving The 340b Program

We are pleased that two of three recent U.S. District Court opinions involving the 340B Program agree with HRSA that three pharmaceutical manufacturers have unlawfully restricted access to 340B discounted drugs by covered entities that dispense medications through contract pharmacy arrangements the core finding of HRSA’s May 17, 2021, Violation Letters. HRSA respectfully disagrees with the recent District Court opinion finding that two other manufacturers had not violated the statute, and continues to evaluate its options.

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. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.

You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

Language Line is available for all in-network providers.

Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

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The Ohio Medicaid Help Page

The Ohio Medicaid Fee-for-Service Help Page will aid you in finding the information and assistance you may need regarding our program. In order that we may best assist you, please refer to the following:

Additional Information For Providers: For assistance with billing issues, FFS Medical claims and all other issues not addressed above, please contact the Provider Hotline or Access the MITS Portal.Provider Notice regarding FFS Pharmacy Helpdesk Hours

Additional Information For Medicaid Recipients: If you are trying to update your case information -OR- have questions about your case or medical card, please contact your case worker at your Local County Department of Job and Family Services.