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, UCare Advocate 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.

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
See the  2020 Medical Injectable Drugs requiring prior authorization .

 

2021
Care Continuum reviews Medical Drug Prior Authorization requests for all UCare plans. See the 2021 Drug PA bulletin.

To submit an authorization request, use one of the following ways:

  • Online (ePA) via the ExpressPAth Portal at www.express-path.com/.  Providers can submit requests, check on the status of submitted requests, and submit an authorization renewal on the ExpressPAth Portal. The site also provides 24/7 access, potential for real-time approvals, and email notifications once a decision is reached. 
  • Fax an authorization form to Care Continuum at 1-877-266-1871.
  • Call Care Continuum at 1-800-818-6747. 

To request an adjustment to an existing prior authorization:

  • Providers should contact CareContinuum – for 2020 prior authorization changes.
  • The authorization must be active.
  • End date extensions can be completed due to scheduling issues or health reasons (ex: chemo delayed due to blood count) that may prevent the administration of the previously approved drug. 
  • Required information for these requests:
    • Reason for extension.
    • Revised end date.
  • Adjustments are not approved for the reasons listed below. A new review/renewal is required.  
    • Additional drug is requested.
    • The patient is due for a renewal.

Non-participating providers should send requests using this form :

  • by fax to UCare Clinical Services at 612-884-2300.
  • or by mail to UCare, Attn: Clinical Services at P.O. Box 52, Minneapolis, MN 55440-0052.

Providers that received a claim denial due to no authorization in place will continue to work through the provider claims appeal process using the Provider Claim Reconsideration Request Form.

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.
 

Pharmacy Benefit Prior Authorization

Express Scripts - State Medical Assistance Programs and 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 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

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.

 

 

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.

 

 

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.


 

 

FDA Alert on Voluntary Recall of Albuterol Inhalers Manufactured by Perrigo

On Sept. 21, 2020, the FDA announced a voluntary recall of all unexpired albuterol inhalers manufactured by Perrigo. This recall is to the retail pharmacy level. The FDA urges patients to continue using the inhaler they have on hand. UCare’s pharmacy department is contacting impacted members and their providers.

Read the October 6 Bulletin for more information.


 

 

Medication Therapy Management (MTM) Program Update

On Jan. 1, 2021, UCare will introduce new changes to its Medicare Medication Therapy Management (MTM) Program. No changes have been made to the MTM program for Medicaid or Individual and Family Plans (IFP). The MTM Program is a free service for eligible UCare members to optimize their medication therapy and experience.
 
 
 
 
 

Changes to the Payment and Remittance Selection Process

Effective immediately, UCare is changing the process to request updates to the provider’s payment and remittance selections.

Read the Dec. 18 bulletin for additional details on the changes.

 

 

 

January 2021 Health Lines

Learn about the MH-SUD Access Line, Inpatient Hospital Readmission Payment Policy, new UCare Coverage Policies, Face-To-Face Interpreting requirement, UCare Foundation distributions, new resource for Youth with Disabilities, Maintenance of Medical Records and more. 
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New Prior Authorization Requirement for Victoza and Nubeqa

Starting March 1, 2021, UCare is adding a prior authorization requirement for Victoza and Nubeqa for members on UCare Individual & Family Plans and UCare Individual & Family Plans with M Health Fairview. 

See the Jan 15, 2021 Provider Bulletin for details.

 

 

 

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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. 

Go to the 2020 Provider Manual page.