Pharmacy

Information by UCare Plan

 

UCare Individual & Family Plans

 

Commercial products for individual and family coverage available through MNsure, including UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview.

Medicare Programs

 

UCare Medicare Plans, UCare Medicare Plans with M Health Fairview and North Memorial, UCare Medicare Group Plans and EssentiaCare.

Medicare + Medical Assistance

 

UCare Connect + Medicare and Minnesota Senior Health Options (MSHO)

State Medical Assistance Programs

 

UCare Connect (Special Needs BasicCare), Minnesota Senior Care Plus (MSC Plus), MinnesotaCare (MnCare), Prepaid Medical Assistance Program (PMAP)

 

Resources & Information

 

Electronic Prior Authorization (ePA): 

ePA is the preferred method to submit Prior Authorization requests to Express Scripts for pharmacy benefit drugs. Providers may use ePA through ExpressPAth, Surescripts, CoverMyMeds or through the Electronic Health Record.

Starting Jan 1, 2020, prior authorization requests for medical drugs administered in a doctor's office will be reviewed by Care Continuum, a subsidiary of Express Scripts. See information in Medical Injectable Drug Prior Authorization Resources. 

2020

Beginning Jan.1, 2020, Care Continuum, a subsidiary of Express Scripts, will review Medical Drug Prior Authorization requests for all UCare plans. See the 2020 Medical Drug PA bulletin.

See more information by selecting a UCare Plan at the top of this page and reviewing Medical Injectable Drug Prior Authorization Resources.  

The Pharmacy and Therapeutics Committee, a group of practicing physicians and pharmacists, meets up to six times per year to recommend medication inclusion or exclusion to our formularies. The Pharmacy and Therapeutics Committee evaluates drugs based on clinical evidence and efficacy (drug monographs, peer reviewed literature, compendia resources), therapeutic guidelines, medication safety and comparable data to other therapeutic alternatives. This committee reviews all new drugs approved by the FDA, new generics, new dosage forms, new indications as well as regular therapeutic class reviews and annual review of all utilization management criteria.

January 2019 Decisions


 

Pharmacy Benefit Prior Authorization

Express Scripts - State Medical Assistance Programs, 2018 UCare Choices, and 2019 UCare Individual & Family Plans
Phone: 1-877-558-7523
Fax: 1-877-251-5896  
 
Express Scripts - Medicare, Medicare + Medical Assistance (dual eligibles)
Phone: 1-877-558-7521
Fax: 1-877-251-5896 

Medical Injectable Drug Prior Authorization

Care Continuum, a subsidiary of Express Scripts
Online (ePA): ExpressPAth Portal at www.express-path.com/.
Phone: 1-800-818-6747 
Fax: 1-877-266-1871

UCare Clinical Services Intake
Fax: 612-884-2300
 
Specialty Pharmacy Contact Information
Fairview Specialty Pharmacy
Phone: 612-672-5260 or 1-800-595-7140 toll free
Fax: 1-866-347-4939
* exclusive network provider of specialty drugs for 2018 UCare Choices, 2019 UCare Individual & Family Plans and State Medical Assistance Programs
 
Accredo
 

Mail Order Contact Information

Express Scripts Mail Order Pharmacy
Phone: 1-866-544-7950  
Fax: 1-800-837-0959  
ePrescribing: Express Scripts Home Delivery Pharmacy   
If you have other questions, contact the Provider Assistance Center:

612-676-3300 or 1-888-531-1493
Hours:  8 a.m. to 5 p.m.,  Monday through Friday

Newsletters & Alerts

 

See Full Provider News Library

FDA Recall of Certain Manufacturers of Metformin Extended-Release Tablets

On May 28, 2020, the Food and Drug Administration (FDA) announced they requested five drug manufacturers to voluntarily recall their Metformin Extended-Release (ER) products from the marketplace due to higher than acceptable levels of N-Nitrosodimethylamine (NDMA). Impacted manufacturers have submitted recall notices to the FDA. 

Read the June 11 Provider Bulletin for details on which manufacturers are affected, what prescribers should do and how UCare is notifying impacted members.

 

 

August 2020 Health Lines

Read about the UCare Provider Manual Update, Holiday Closure Hours, New Member ID Card Design Reminder, Documentation Improvement for Rheumatoid Arthritis, LivingWell Kid Kits, Member Rights and Responsibilities and the Provider Relief Fund Application Deadline Update.
 

 

 

 

UCare Introduces New Medical Services and Medical Injectable Drugs Prior Authorization and Pre-Determination Forms

Providers should transition to the new forms by July 1.

 

Read the Prior Authorization and Pre-Determination Forms provider bulletin.


 

 

2020 Changes to Medical Benefit Drug Prior Authorizations

Beginning Jan. 1, 2020, Care Continuum, a subsidiary of Express Scripts, will be performing Medical Benefit Drug Prior Authorization reviews for all of UCare’s lines of business. Learn about how to initiate prior authorization requests with Care Continuum, which medical drugs requiring prior authorization and additional changes for 2020 and Biosimilar step therapy for medical drugs in 2020.

Read the 2020 Drug PA Bulletin. 

 

 

Pharmacy Access – Disruption Due to Protests

Access to certain pharmacies may be limited because of temporary closures or building disruptions. UCare has prepared information to answer questions you may have for your patients.

Read the Pharmacy Access Bulletin. 

 

 

 

Market Withdrawal Alert – Ranitidine (Zantac) Products

The FDA requested a market withdrawal of all remaining OTC and prescription ranitidine drugs due to an impurity detected in the products.

Read the Market Withdrawal bulletin  for additional information.

 

 

 

Revised - UCare Pharmacy COVID-19 Updates

UCare’s Pharmacy Department has been closely monitoring the COVID-19 developments and taking appropriate action to ensure our members have access to medication.  

Read the revised Provider Bulletin

 

 

 

Pharmacy Formulary and Benefit Changes for 2020

The 2020 UCare pharmacy formulary changes are now available on the ucare.org/providers website. From the Pharmacy page, you can find the 2019 and 2020 formularies for each health plan. Also covered is a $25 copay cap for each covered insulin prescription filled for UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview with a list of covered formulary insulin and a summary of formulary changes for Medicare and Individual & Family Plans.

Read the 2020 Formulary Changes bulletin .

 

 

Temporary Changes to Post-Acute Care Authorization & Notification Requirements

UCare is temporarily changing prior authorization and notification requirements for certain post-acute care services effective for dates of services April 20, 2020, to June 30, 2020, in response to COVID-19. 

Read the April 20 Bulletin.

 

 

Inhaler Preferred Drug List Status Changes 

Coverage for Advair Diskus and Ventolin HFA inhaler products on the UCare Minnesota State Health Care Programs formulary will change on Oct. 1, 2019. Proactive review of preferred alternative products, if appropriate, can be made prior to the effective date.  
 
Read the Sept. 6 bulletin for the inhalers and health plans impacted.
 
 
 
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UCare Implements New Transportation Management Software

UCare has rolled out a new transportation system to schedule rides for our members. The new service will continue to be called UCare HealthRide.

 

Read the June 22 Provider Bulletin.

 

 

 

Q4 2020 Update to UCare's Provider Manual

UCare’s 2020 Provider Manual contains critical information that providers need to know to effectively work with UCare and our members. It is important that providers reference the online manual regularly for up-to-date content. The Provider Manual has been updated to reflect current business practices. UCare has prepared a Provider Bulletin outlining the key updates.

Go to the  2020 Provider Manual